Note: This publication is a compilation of the text of selected defense-related health laws, as amended through January 24, 2004, prepared for the Committee on Armed Services of the House of Representatives. While this publication

does not represent an official version of any Federal statute,

substantial efforts have been made to ensure the accuracy

of its contents. The official version of Federal law is found

in the United States Statutes at Large and in the United

States Code; the legal effect to be given to the Statutes at

Large and the United States Code is established by statute

(1 U.S.C. 112, 204).

Please report any errors to the Committee.
U.S. GOVERNMENT PRINTING OFFICE

91–298 WASHINGTON : 

" ! COMMITTEE PRINT 108th Congress

2d Session

No. 5

2004

DEFENSE-RELATED HEALTH LAWS

(As Amended Through January 23, 2004)

DEFENSE-RELATED LAWS — VOLUME III

PREPARED FOR THE USE OF THE

COMMITTEE ON ARMED SERVICES

OF THE

HOUSE OF REPRESENTATIVES

APRIL 2004

Printed for the use of the Committee on

Armed Services of the House of Representatives

http: //www.house.gov/hasc

For sale by the Superintendent of Documents, U.S. Government Printing Office

Internet: http://bookstore.gpo.gov Phone: (202) 512–1800 Fax: (202) 512–2250

Mail: Stop SSOP, Washington, DC 20402–0001
HOUSE COMMITTEE ON ARMED SERVICES

ONE HUNDRED EIGHTH CONGRESS

DUNCAN HUNTER, California, Chairman

CURT WELDON, Pennsylvania

JOEL HEFLEY, Colorado

JIM SAXTON, New Jersey

JOHN M. MCHUGH, New York

TERRY EVERETT, Alabama

ROSCOE G. BARTLETT, Maryland

HOWARD P. ‘‘BUCK’’ MCKEON, California

MAC THORNBERRY, Texas

JOHN N. HOSTETTLER, Indiana

WALTER B. JONES, North Carolina

JIM RYUN, Kansas

JIM GIBBONS, Nevada

ROBIN HAYES, North Carolina

HEATHER WILSON, New Mexico

KEN CALVERT, California

ROB SIMMONS, Connecticut

JO ANN DAVIS, Virginia

ED SCHROCK, Virginia

W. TODD AKIN, Missouri

J. RANDY FORBES, Virginia

JEFF MILLER, Florida

JOE WILSON, South Carolina

FRANK A. LOBIONDO, New Jersey

TOM COLE, Oklahoma

JEB BRADLEY, New Hampshire

ROB BISHOP, Utah

MICHAEL TURNER, Ohio

JOHN KLINE, Minnesota

CANDICE S. MILLER, Michigan

PHIL GINGREY, Georgia

MIKE ROGERS, Alabama

TRENT FRANKS, Arizona

IKE SKELTON, Missouri

JOHN SPRATT, South Carolina

SOLOMON P. ORTIZ, Texas

LANE EVANS, Illinois

GENE TAYLOR, Mississippi

NEIL ABERCROMBIE, Hawaii

MARTY MEEHAN, Massachusetts

SILVESTRE REYES, Texas

VIC SNYDER, Arkansas

JIM TURNER, Texas

ADAM SMITH, Washington

LORETTA SANCHEZ, California

MIKE MCINTYRE, North Carolina

CIRO D. RODRIGUEZ, Texas

ELLEN O. TAUSCHER, California

ROBERT A. BRADY, Pennsylvania

BARON P. HILL, Indiana

JOHN B. LARSON, Connecticut

SUSAN A. DAVIS, California

JAMES R. LANGEVIN, Rhode Island

STEVE ISRAEL, New York

RICK LARSEN, Washington

JIM COOPER, Tennessee

JIM MARSHALL, Georgia

KENDRICK B. MEEK, Florida

MADELEINE Z. BORDALLO, Guam

RODNEY ALEXANDER, Louisiana

TIM RYAN, Ohio

ROBERT S. RANGEL, Staff Director

(ii)
iii

SUMMARY OF CONTENTS

Page

Title 10—United States Code—Armed Forces (selected provisions) ......................................................................................... 1

Defense Authorization Acts (selected provisions) ..................... 99

Defense Appropriations Acts (selected provisions) ................... 171

Miscellaneous defense-related health laws ............................... 177

Tables ........................................................................................... 213
(iv)

For changes after the closing date of this publication (January

23, 2004) to provisions of law in this publication that have citations

to the United States Code, see the United States Code Classification Tables published by the Office of the Law Revision Counsel of

the House of Representatives at http://uscode.house.gov/

uscct.htm.
v

C O N T E N T S

Page

Summary of Contents .............................................................................................. iii

Table of Contents ..................................................................................................... v

Selected provisions of title 10, United States Code—Armed Forces:

Chapter 55. Medical and Dental Care ................................................................... 3

Section:

1071. Purpose of this chapter .................................................................... 4

1072. Definitions ......................................................................................... 4

1073. Administration of this chapter ........................................................ 7

1073a. Contracts for health care: best value contracting ......................... 7

1074. Medical and dental care for members and certain former members ................................................................................................................. 8

1074a. Medical and dental care: members on duty other than active

duty for a period of more than 30 days ....................................................... 10

[1074b. Repealed.] ........................................................................................... 11

1074c. Medical care: authority to provide a wig ........................................ 11

1074d. Certain primary and preventive health care services .................. 11

1074e. Medical care: certain Reserves who served in Southwest Asia

during the Persian Gulf Conflict ................................................................. 12

1074f. Medical tracking system for members deployed overseas ............. 13

1074g. Pharmacy benefits program ............................................................ 13

1074h. Medical and dental care: medal of honor recipients; dependents 17

1074i. Reimbursement for certain travel expenses ................................... 17

1074j. Sub-acute care program ................................................................... 17

1074k. Long-term care insurance ............................................................... 18

1075. Officers and certain enlisted members: subsistence charges ........ 86

1076. Medical and dental care for dependents: general rule .................. 19

1076a. TRICARE dental program ............................................................... 21

1076b. TRICARE program: coverage for members of the Ready Reserve ............................................................................................................... 24

1076c. Dental insurance plan: certain retirees and their surviving

spouses and other dependents ..................................................................... 26

1077. Medical care for dependents: authorized care in facilities of

uniformed services ........................................................................................ 28

1078. Medical and dental care for dependents: charges .......................... 30

1078a. Continued health benefits coverage ............................................... 30

1079. Contracts for medical care for spouses and children: plans ......... 34

1079a. CHAMPUS: treatment of refunds and other amounts collected .. 44

1079b. Procedures for charging fees for care provided to civilians; retention and use of fees collected .................................................................. 44

1080. Contracts for medical care for spouses and children: election

of facilities ..................................................................................................... 44

1081. Contracts for medical care for spouses and children: review

and adjustment of payments ........................................................................ 45

1082. Contracts for health care: advisory committees ............................. 45

1083. Contracts for medical care for spouses and children: additional

hospitalization ............................................................................................... 45

1084. Determinations of dependency ........................................................ 46

1085. Medical and dental care from another executive department:

reimbursement .............................................................................................. 46

1086. Contracts for health benefits for certain members, former members, and their dependents ........................................................................... 46

1086a. Certain former spouses: extension of period of eligibility for

health benefits ............................................................................................... 49

1086b. Prohibition against requiring retired members to receive health

care solely through the Department of Defense ......................................... 50
Page

vi

Chapter 55. Medical and Dental Care—Continued

1087. Programing facilities for certain members, former members, and

their dependents in construction projects of the uniformed services ....... 50

1088. Air evacuation patients: furnished subsistence ............................. 51

1089. Defense of certain suits arising out of medical malpractice ......... 51

1090. Identifying and treating drug and alcohol dependence ................. 53

1091. Personal services contracts .............................................................. 53

1092. Studies and demonstration projects relating to delivery of

health and medical care ............................................................................... 54

1093. Performance of abortions: restrictions ............................................ 55

1094. Licensure requirement for health-care professionals .................... 55

1094a. Continuing medical education requirements: system for monitoring physician compliance ......................................................................... 56

1095. Health care services incurred on behalf of covered beneficiaries:

collection from third-party payers ............................................................... 56

1095a. Medical care: members held as captives and their dependents ... 59

1095b. TRICARE program: contractor payment of certain claims ........... 59

1095c. TRICARE program: facilitation of processing of claims ................ 60

1095d. TRICARE program: waiver of certain deductibles ........................ 61

1095e. TRICARE program: beneficiary counseling and assistance coordinators .......................................................................................................... 61

1095f. TRICARE program: referrals for specialty health care ................. 62

1096. Military-civilian health services partnership program ................. 62

1097. Contracts for medical care for retirees, dependents, and survivors: alternative delivery of health care .................................................. 63

1097a. TRICARE Prime: automatic enrollments; payment options ......... 64

1097b. TRICARE program: financial management ................................... 65

1098. Incentives for participation in cost-effective health care plans .... 66

1099. Health care enrollment system ....................................................... 66

1100. Defense Health Program Account ................................................... 67

1101. Resource allocation methods: capitation or diagnosis-related

groups ............................................................................................................ 67

1102. Confidentially of medical quality assurance records: qualified

immunity for participants ............................................................................ 68

1103. Contracts for medical and dental care: State and local preemption ................................................................................................................. 71

1104. Sharing of health-care resources with the Department of Veterans Affairs .................................................................................................. 71

1105. Specialized treatment facility program .......................................... 72

1106. Submittal of claims: standard form; time limits ............................ 73

1107. Notice of use of an investigational new drug or a drug unapproved for its applied use ............................................................................. 73

1107a. Emergency use products .................................................................. 75

1108. Health care coverage through Federal Employees Health Benefits program: demonstration project ............................................................ 76

1109. Organ and tissue donor program .................................................... 80

1110. Anthrax vaccine immunization program; procedures for exemptions and monitoring reactions .................................................................... 80

Chapter 56. Department of Defense Medicare-Eligible Retiree Health Care

Fund ...................................................................................................................... 82

Section:

1111. Establishment and purpose of Fund; definitions; authority to

enter into agreements ................................................................................... 82

1112. Assets of Fund .................................................................................. 83

1113. Payments from the Fund ................................................................. 83

1114. Board of Actuaries ............................................................................ 84

1115. Determination of contributions to the Fund .................................. 85

1116. Payments into the Fund .................................................................. 87

1117. Investment of assets of Fund .......................................................... 89

Chapter 58. Benefits and Services for Members Being Separated or Recently

Separated .............................................................................................................. 91

Section:

1142. Preseparation counseling; transmittal of medical records to Department of Veterans Affairs ....................................................................... 91

1145. Health benefits ................................................................................. 92
Page

vii

Chapter 59. Separation ........................................................................................... 97

Section:

1178. System and procedures for tracking separations resulting from

refusal to participate in anthrax vaccine immunization program ............ 97

Selected provisions of Defense Authorization Acts:

NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEAR 2004

(P.L. 108–136) ....................................................................................................... 101

Sec. 723. [10 U.S.C. 1073 note] Surveys on continued viability of

TRICARE Standard.

Sec. 724. [10 U.S.C. 1079 note] Plan for providing health coverage information to members, former members, and dependents eligible for certain health benefits.

Sec. 727. [38 U.S.C. 320 note] Joint program for development and evaluation of integrated healing care practices for members of the Armed

Forces and veterans.

BOB STUMP NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL

YEAR 2003 (P.L. 107–314) .................................................................................. 105

Sec. 708. [10 U.S.C. 1071 note] Access to health care services for beneficiaries eligible for TRICARE and Department of Veterans Affairs

health care.

Sec. 721. Revised coordination and sharing guidelines.

Sec. 722. [38 U.S.C. 8111 note] Health care resources sharing and coordination project.

Sec. 723. Report on improved coordination and sharing of health care

and health care resources following domestic acts of terrorism or domestic use of weapons of mass destruction.

Sec. 724. [10 U.S.C. 1074g note] Interoperability of Department of Veterans Affairs and Department of Defense pharmacy data systems.

Sec. 725. [10 U.S.C. 1094a note] Joint pilot program for providing graduate medical education and training for physicians.

Sec. 726. Repeal of certain limits on Department of Veterans Affairs

resources.

NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEAR 2002

(P.L. 107–107) ....................................................................................................... 111

Sec. 734. [10 U.S.C. 1071 note] Pilot program providing for Department

of Veterans Affairs support in the performance of separation physical

examinations.

FLOYD D. SPENCE NATIONAL DEFENSE AUTHORIZATION ACT FOR

FISCAL YEAR 2001 (as enacted by P.L. 106–398) ........................................... 113

Sec. 702. [10 U.S.C. 1092 note] Chiropractic health care for members

on active duty.

Sec. 721. [10 U.S.C. 1073 note] Improvement of access to health care

under the TRICARE program.

Sec. 723. [10 U.S.C. 1073 note] Modernization of TRICARE business

practices and increase of use of military treatment facilities.

Sec. 724. [10 U.S.C. 1073 note] Extension of TRICARE managed care

support contracts.

Sec. 727. Claims processing improvements.

Sec. 731. [10 U.S.C. 1092 note] Demonstration project for expanded access to mental health counselors.

Sec. 732. [10 U.S.C. 1092 note] Teleradiology demonstration project.

Sec. 733. [10 U.S.C. 1071 note] Health care management demonstration

program.

Sec. 741. [38 U.S.C. 8111 note] VA-DOD sharing agreements for health

services.

Sec. 742. [10 U.S.C. 1071 note] Processes for patient safety in military

and veterans health care systems.

Sec. 743. [10 U.S.C. 1071 note] Cooperation in developing pharmaceutical identification technology.

Sec. 754. [10 U.S.C. 1071 note] Patient care reporting and management

system.
Page

viii

NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEAR 2000

(P.L. 106–65) ......................................................................................................... 123

Sec. 703. [10 U.S.C. 1077 note] Provision of domiciliary and custodial

care for certain CHAMPUS beneficiaries. [repealed]

Sec. 706. [10 U.S.C. 1074 note] Health care at former uniformed services

treatment facilities for active duty members stationed at certain remote

locations.

Sec. 723. [10 U.S.C. 1071 note] Health care quality information and

technology enhancement.

Sec. 724. [10 U.S.C. 1092 note] Joint telemedicine and telepharmacy

demonstration projects by the Department of Defense and Department

of Veterans Affairs.

STROM THURMOND NATIONAL DEFENSE AUTHORIZATION ACT FOR

FISCAL YEAR 1999 (P.L. 105–261) ................................................................... 127

Sec. 722. [10 U.S.C. 1073 note] TRICARE as supplement to medicare

demonstration.

Sec. 723. [10 U.S.C. 1073 note] Implementation of redesign of pharmacy

system.

Sec. 724. [10 U.S.C. 1108 note] Comprehensive evaluation of implementation of demonstration projects and TRICARE pharmacy redesign.

Sec. 745. [10 U.S.C. 1071 note] Joint Department of Defense and Department of Veterans Affairs reports relating to interdepartmental cooperation in the delivery of medical care.

NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEAR 1998

(P.L. 105–85) ......................................................................................................... 136

Sec. 731. [10 U.S.C. 1074 note] Improvements in health care coverage

and access for members assigned to certain duty locations far from

sources of care.

Sec. 743. Authority for agreement for use of medical resource facility,

Alamogordo, New Mexico.

Sec. 744. [10 U.S.C. 1073 note] Disclosures of cautionary information

on prescription medications.

Sec. 745. [10 U.S.C. 1073 note] Competitive procurement of certain ophthalmic services.

Sec. 1078. [50 U.S.C. 1520a] Restrictions on the use of human subjects

for testing of chemical or biological agents.

NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEAR 1997

(P.L. 104–201) ....................................................................................................... 143

Sec. 721. [10 U.S.C. 1073 note] Definitions.

Sec. 722. [10 U.S.C. 1073 note] Inclusion of designated providers in uniformed services health care delivery system.

Sec. 723. [10 U.S.C. 1073 note] Provision of uniform benefit by designated providers.

Sec. 724. [10 U.S.C. 1073 note] Enrollment of covered beneficiaries.

Sec. 725. [10 U.S.C. 1073 note] Application of CHAMPUS payment rules.

Sec. 726. [10 U.S.C. 1073 note] Payments for services.

Sec. 727. [10 U.S.C. 1073 note] Repeal of superseded authorities.

Sec. 742. [10 U.S.C. 1071 note] External peer review for defense health

program extramural medical research involving human subjects.

Sec. 743. [10 U.S.C. 1074 note] Independent research regarding Gulf

War syndrome.
Page

ix

NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEAR 1996

(P.L. 104–106) ....................................................................................................... 151

Sec. 711. Definition of TRICARE program.

Sec. 715. [10 U.S.C. 1073 note] Training in health care management

and administration for TRICARE lead agents.

Sec. 717. [10 U.S.C. 1073 note] Evaluation and report on TRICARE program effectiveness.

Sec. 743. [10 U.S.C. 1086 note] Waiver of collection of payments due

from certain persons unaware of loss of CHAMPUS eligibility.

NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEAR 1995

(P.L. 103–337) ....................................................................................................... 154

Sec. 704. [10 U.S.C. 1091 note] Authorization for medical and dental

care for abused dependents of certain members.

Sec. 721. [10 U.S.C. 1074 note] Programs related to Desert Storm mystery illness.

NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEAR 1994

(P.L. 103–160) ....................................................................................................... 158

Sec. 731. [10 U.S.C. 1073 note] Use of health maintenance organization

model as option for military health care.

NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEAR 1993

(P.L. 102–484) ....................................................................................................... 160

Sec. 702. [10 U.S.C. 1079 note] Programs relating to the sale of pharmaceuticals.

Sec. 711. [10 U.S.C. 1106 note] National claims processing system for

CHAMPUS.

Sec. 712. [10 U.S.C. 1073 note] Condition on expansion of CHAMPUS

reform initiative to other locations.

Sec. 715. Positive incentives under the coordinated care program.

Sec. 722. [10 U.S.C. 1073 note] Military health care for persons reliant

on health care facilities at bases being closed or realigned.

Sec. 724. [10 U.S.C. 1071 note] Annual beneficiary survey.

NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEARS 1992

AND 1993 (P.L. 102–190) .................................................................................... 168

Sec. 722. [10 U.S.C. 1073 note] Authorization for the extension of

CHAMPUS reform initiative.

Sec. 734. [10 U.S.C. 1074 note] Registry of members of the Armed Forces

exposed to fumes of burning oil in connection with Operation Desert

Storm.

NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEAR 1991

(P.L. 101–510) ....................................................................................................... 170

Sec. 715. [10 U.S.C. 1073 note] Conditions on expansion of CHAMPUS

reform initiative.

Selected provisions of Department of Defense Appropriations Acts:

Department of Defense Appropriations Act, 2004 (P.L. 108–87; §§ 8009,

8017, 8024, 8026, 8054, 8060, 8078, 8089, 8093) ....................................... 172

Department of Defense Appropriations Act, 2001 (P.L. 106–259; § 8090) ... 175

Miscellaneous defense-related health laws:

HEALTH CARE ISSUES RELATING TO GULF WAR VETERANS: ................ 179

Persian Gulf War Veterans’ Benefits Act (title I of P.L. 104–446)

Persian Gulf War Veterans’ Health Status Act (title VII of P.L. 102–

585)
Page

x

HEALTH CARE SHARING AGREEMENTS BETWEEN DEPARTMENT OF

DEFENSE AND DEPARTMENT OF VETERANS AFFAIRS: ......................... 192

Sections 8111 and 8111A of title 38, U.S.C.

Section 113 of the Veterans Millennium Health Care and Benefits Act

(P.L. 106–117; 38 U.S.C. 8111 note)

Title II of the Veterans Health Care Act of 1992 (P.L. 102–585; 38

U.S.C. 8111 note)

MEDICARE SUBVENTION PROJECT FOR MILITARY RETIREES: .............. 204

Section 1986 of title XVIII of the Social Security Act (42 U.S.C. 1395ggg)

Tables:

List of laws by public law number .................................................................. 215

List of laws by short title or popular name .................................................... 217

List of laws by subject matter ......................................................................... 219
1

SELECTED PROVISIONS OF TITLE 10, UNITED STATES

CODE

3

1 In addition to the provisions set forth in this chapter, numerous provisions of law applicable

to medical and dental care for members of the uniformed services are enacted in annual defense

authorization and defense appropriations Acts. Provisions from those Acts that are of general

and continuing applicability, including provisions relating to Uniformed Services Treatment Facilities, the CHAMPUS Reform Initiative, and the TRICARE program, are set forth starting on

page 99 of this committee print publication.

SELECTED PROVISIONS OF TITLE 10, UNITED STATES

CODE

* * * * * * *

CHAPTER 55—MEDICAL AND DENTAL CARE 1

Sec.

1071. Purpose of this chapter.

1072. Definitions.

1073. Administration of this chapter.

1073a. Contracts for health care: best value contracting.

1074. Medical and dental care for members and certain former members.

1074a. Medical and dental care: members on duty other than active duty for a

period of more than 30 days.

[1074b. Repealed.]

1074c. Medical care: authority to provide a wig.

1074d. Certain primary and preventive health care services.

1074e. Medical care: certain Reserves who served in Southwest Asia during the

Persian Gulf Conflict.

1074f. Medical tracking system for members deployed overseas.

1074g. Pharmacy benefits program.

1074h. Medical and dental care: medal of honor recipients; dependents.

1074i. Reimbursement for certain travel expenses.

1074j. Sub-acute care program.

1074k. Long-term care insurance.

1075. Officers and certain enlisted members: subsistence charges.

1076. Medical and dental care for dependents: general rule.

1076a. TRICARE dental program.

1076b. TRICARE program: coverage for members of the Ready Reserve.

1076c. Dental insurance plan: certain retirees and their surviving spouses and

other dependents.

1077. Medical care for dependents: authorized care in facilities of uniformed

services.

1078. Medical and dental care for dependents: charges.

1078a. Continued health benefits coverage.

1079. Contracts for medical care for spouses and children: plans.

1079a. CHAMPUS: treatment of refunds and other amounts collected.

1079b. Procedures for charging fees for care provided to civilians; retention and

use of fees collected.

1080. Contracts for medical care for spouses and children: election of facilities.

1081. Contracts for medical care for spouses and children: review and

adjustment of payments.

1082. Contracts for health care: advisory committees.

1083. Contracts for medical care for spouses and children: additional

hospitalization.

1084. Determinations of dependency.

1085. Medical and dental care from another executive department:

reimbursement.

1086. Contracts for health benefits for certain members, former members, and

their dependents.
§ 1071 CH. 55—MEDICAL AND DENTAL CARE 4

1086a. Certain former spouses: extension of period of eligibility for health benefits.

1086b. Prohibition against requiring retired members to receive health care solely

through the Department of Defense.

1087. Programing facilities for certain members, former members, and their

dependents in construction projects of the uniformed services.

1088. Air evacuation patients: furnished subsistence.

1089. Defense of certain suits arising out of medical malpractice.

1090. Identifying and treating drug and alcohol dependence.

1091. Personal services contracts.

1092. Studies and demonstration projects relating to delivery of health and

medical care.

1093. Performance of abortions: restrictions.

1094. Licensure requirement for health-care professionals.

1094a. Continuing medical education requirements: system for monitoring physician compliance.

1095. Health care services incurred on behalf of covered beneficiaries: collection

from third-party payers.

1095a. Medical care: members held as captives and their dependents.

1095b. TRICARE program: contractor payment of certain claims.

1095c. TRICARE program: facilitation of processing of claims.

1095d. TRICARE program: waiver of certain deductibles.

1095e. TRICARE program: beneficiary counseling and assistance coordinators.

1095f. TRICARE program: referrals for specialty health care.

1096. Military-civilian health services partnership program.

1097. Contracts for medical care for retirees, dependents, and survivors:

alternative delivery of health care.

1097a. TRICARE Prime: automatic enrollments; payment options.

1097b. TRICARE program: financial management.

1098. Incentives for participation in cost-effective health care plans.

1099. Health care enrollment system.

1100. Defense Health Program Account.

1101. Resource allocation methods: capitation or diagnosis-related groups.

1102. Confidentially of medical quality assurance records: qualified immunity for

participants.

1103. Contracts for medical and dental care: State and local preemption.

1104. Sharing of health-care resources with the Department of Veterans Affairs.

1105. Specialized treatment facility program.

1106. Submittal of claims: standard form; time limits.

1107. Notice of use of an investigational new drug or a drug unapproved for its

applied use.

1107a. Emergency use products.

1108. Health care coverage through Federal Employees Health Benefits program: demonstration project.

1109. Organ and tissue donor program.

1110. Anthrax vaccine immunization program; procedures for exemptions and

monitoring reactions.

§ 1071. Purpose of this chapter

The purpose of this chapter is to create and maintain high morale in the uniformed services by providing an improved and uniform program of medical and dental care for members and certain

former members of those services, and for their dependents.

(Added P.L. 85–861, § 1(25)(B), Sept. 2, 1958, 72 Stat. 1445; amended P.L. 89–614, § 2(1), Sept.

30, 1966, 80 Stat. 862; P.L. 96–513, § 511(34)(A), (B), Dec. 12, 1980, 94 Stat. 2922.)

§ 1072. Definitions

In this chapter:

(1) The term ‘‘uniformed services’’ means the armed forces

and the Commissioned Corps of the National Oceanic and Atmospheric Administration and of the Public Health Service.

(2) The term ‘‘dependent’’, with respect to a member or

former member of a uniformed service, means—

(A) the spouse;
5 § 1072 CH. 55—MEDICAL AND DENTAL CARE

(B) the unremarried widow;

(C) the unremarried widower;

(D) a child who—

(i) has not attained the age of 21;

(ii) has not attained the age of 23, is enrolled in

a full-time course of study at an institution of higher

learning approved by the administering Secretary and

is, or was at the time of the member’s or former member’s death, in fact dependent on the member or

former member for over one-half of the child’s support;

or

(iii) is incapable of self-support because of a mental or physical incapacity that occurs while a dependent of a member or former member under clause (i) or

(ii) and is, or was at the time of the member’s or

former member’s death, in fact dependent on the

member or former member for over one-half of the

child’s support;

(E) a parent or parent-in-law who is, or was at the

time of the member’s or former member’s death, in fact dependent on him for over one-half of his support and residing in his household;

(F) the unremarried former spouse of a member or

former member who (i) on the date of the final decree of

divorce, dissolution, or annulment, had been married to

the member or former member for a period of at least 20

years during which period the member or former member

performed at least 20 years of service which is creditable

in determining that member’s or former member’s eligibility for retired or retainer pay, or equivalent pay, and (ii)

does not have medical coverage under an employer-sponsored health plan;

(G) a person who (i) is the unremarried former spouse

of a member or former member who performed at least 20

years of service which is creditable in determining the

member or former member’s eligibility for retired or retainer pay, or equivalent pay, and on the date of the final

decree of divorce, dissolution, or annulment before April 1,

1985, had been married to the member or former member

for a period of at least 20 years, at least 15 of which, but

less than 20 of which, were during the period the member

or former member performed service creditable in determining the member or former member’s eligibility for retired or retainer pay, and (ii) does not have medical coverage under an employer-sponsored health plan;

(H) a person who would qualify as a dependent under

clause (G) but for the fact that the date of the final decree

of divorce, dissolution, or annulment of the person is on or

after April 1, 1985, except that the term does not include

the person after the end of the one-year period beginning

on the date of that final decree; and

(I) an unmarried person who—

(i) is placed in the legal custody of the member or

former member as a result of an order of a court of

competent jurisdiction in the United States (or a Ter-
§ 1072 CH. 55—MEDICAL AND DENTAL CARE 6

ritory or possession of the United States) for a period

of at least 12 consecutive months;

(ii) either—

(I) has not attained the age of 21;

(II) has not attained the age of 23 and is enrolled in a full time course of study at an institution of higher learning approved by the administering Secretary; or

(III) is incapable of self support because of a

mental or physical incapacity that occurred while

the person was considered a dependent of the

member or former member under this subparagraph pursuant to subclause (I) or (II);

(iii) is dependent on the member or former member for over one-half of the person’s support;

(iv) resides with the member or former member

unless separated by the necessity of military service or

to receive institutional care as a result of disability or

incapacitation or under such other circumstances as

the administering Secretary may by regulation prescribe; and

(v) is not a dependent of a member or a former

member under any other subparagraph.

(3) The term ‘‘administering Secretaries’’ means the Secretaries of executive departments specified in section 1073 of this

title as having responsibility for administering this chapter.

(4) The term ‘‘Civilian Health and Medical Program of the

Uniformed Services’’ means the program authorized under sections 1079 and 1086 of this title and includes contracts entered

into under section 1091 or 1097 of this title and demonstration

projects under section 1092 of this title.

(5) The term ‘‘covered beneficiary’’ means a beneficiary

under this chapter other than a beneficiary under section

1074(a) of this title.

(6) The term ‘‘child’’, with respect to a member or former

member of a uniformed service, means the following:

(A) An unmarried legitimate child.

(B) An unmarried adopted child.

(C) An unmarried stepchild.

(D) An unmarried person—

(i) who is placed in the home of the member or

former member by a placement agency (recognized by

the Secretary of Defense) in anticipation of the legal

adoption of the person by the member or former member; and

(ii) who otherwise meets the requirements specified in paragraph (2)(D).

(7) The term ‘‘TRICARE program’’ means the managed

health care program that is established by the Department of

Defense under the authority of this chapter, principally section

1097 of this 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.
7 § 1073a CH. 55—MEDICAL AND DENTAL CARE

(8) The term ‘‘custodial care’’ means treatment or services,

regardless of who recommends such treatment or services or

where such treatment or services are provided, that—

(A) can be rendered safely and reasonably by a person

who is not medically skilled; or

(B) is or are designed mainly to help the patient with

the activities of daily living.

(9) The term ‘‘domiciliary care’’ means care provided to a

patient in an institution or homelike environment because—

(A) providing support for the activities of daily living

in the home is not available or is unsuitable; or

(B) members of the patient’s family are unwilling to

provide the care.

(Added P.L. 85–861, § 1(25)(B), Sept. 2, 1958, 72 Stat. 1446; amended P.L. 89–614, § 2(1), Sept.

30, 1966, 80 Stat. 862; P.L. 89–718, § 8(a), Nov. 2, 1966, 80 Stat. 1117; P.L. 96–513, § 115(b),

§ 511(34)(A), (35), (36), Dec. 12, 1980, 94 Stat. 2877, 2922, 2923; P.L. 97–252, § 1004(a), Sept.

8, 1982, 96 Stat. 737; P.L. 98–525, § 645(a), Oct. 19, 1984, 98 Stat. 2548; P.L. 98–557,

§ 19(1), Oct. 30, 1984, 98 Stat. 2869; P.L. 99–661, § 701(b), Nov. 14, 1986, 100 Stat. 3898; P.L.

101–189, § 731(a), Nov. 29, 1989, 103 Stat. 1481; P.L. 102–484, § 706, Oct. 23, 1992, 106 Stat.

2433; P.L. 103–160, § 702(a), Nov. 30, 1993, 107 Stat. 1686; P.L. 103–337, § 701(a), Oct. 5, 1994,

108 Stat. 2992; P.L. 105–85, § 711, Nov. 18, 1997, 111 Stat. 1808; P.L. 107–107, § § 701(c),

708(a)(1), Dec. 28, 2001, 115 Stat. 1160, 1164.)

§ 1073. Administration of this chapter

(a) RESPONSIBLE OFFICIALS.—Except as otherwise provided in

this chapter, the Secretary of Defense shall administer this chapter

for the armed forces under his jurisdiction, the Secretary of Homeland Security shall administer this chapter for the Coast Guard

when the Coast Guard is not operating as a service in the Navy,

and the Secretary of Health and Human Services shall administer

this chapter for the National Oceanic and Atmospheric Administration and the Public Health Service. This chapter shall be administered consistent with the Assisted Suicide Funding Restriction Act

of 1997 (42 U.S.C. 14401 et seq.).

(b) STABILITY IN PROGRAM OF BENEFITS.—The Secretary of Defense shall, to the maximum extent practicable, provide a stable

program of benefits under this chapter throughout each fiscal year.

To achieve the stability in the case of managed care support contracts entered into under this chapter, the contracts shall be administered so as to implement all changes in benefits and administration on a quarterly basis. However, the Secretary of Defense

may implement any such change prior to the next fiscal quarter if

the Secretary determines that the change would significantly improve the provision of care to eligible beneficiaries under this chapter.

(Added P.L. 85–861, § 1(25)(B), Sept. 2, 1958, 72 Stat. 1446; amended P.L. 89–614, § 2(1), Sept.

30, 1966, 80 Stat. 862; P.L. 89–718, § 8(a), Nov. 2, 1966, 80 Stat. 1117; P.L. 96–513, § 511(34)(A),

(C), (35), (36), Dec. 12, 1980, 94 Stat. 2922, 2923; P.L. 98–557, § 19(2), Oct. 30, 1984, 98 Stat.

2869; P.L. 105–12, § 9(h), Apr. 30, 1997, 111 Stat. 27; P.L. 106–65, §§ 725, 1066(a)(7), Oct. 5,

1999, 113 Stat. 698, 770; P.L. 107–296, § 1704(b)(1), Nov. 25, 2002, 116 Stat. 2314.)

§ 1073a. Contracts for health care: best value contracting

(a) AUTHORITY.—Under regulations prescribed by the administering Secretaries, health care contracts shall be awarded in the

administration of this chapter to the offeror or offerors that will

provide the best value to the United States to the maximum extent

consistent with furnishing high-quality health care in a manner

that protects the fiscal and other interests of the United States.
§ 1074 CH. 55—MEDICAL AND DENTAL CARE 8

(b) FACTORS CONSIDERED.—In the determination of best value

under subsection (a)—

(1) consideration shall be given to the factors specified in

the regulations; and

(2) greater weight shall be accorded to technical and performance-related factors than to cost and price-related factors.

(c) APPLICABILITY.—The authority under the regulations prescribed under subsection (a) shall apply to any contract in excess

of $5,000,000.

(Added P.L. 106–65, § 722(a), Oct. 5, 1999, 113 Stat. 695.)

§ 1074. Medical and dental care for members and certain

former members

(a)(1) Under joint regulations to be prescribed by administering

Secretaries, a member of a uniformed service described in paragraph (2) is entitled to medical and dental care in any facility of

any uniformed service.

(2) Members of the uniformed services referred to in paragraph

(1) are as follows:

(A) A member of a uniformed service on active duty.

(B) A member of a reserve component of a uniformed service who has been commissioned as an officer if—

(i) the member has requested orders to active duty for

the member’s initial period of active duty following the

commissioning of the member as an officer;

(ii) the request for orders has been approved;

(iii) the orders are to be issued but have not been

issued; and

(iv) the member does not have health care insurance

and is not covered by any other health benefits plan.

(b) Under joint regulations to be prescribed by the administering Secretaries, a member or former member of a uniformed

service who is entitled to retired or retainer pay, or equivalent pay

may, upon request, be given medical and dental care in any facility

of any uniformed service, subject to the availability of space and facilities and the capabilities of the medical and dental staff. The administering Secretaries may, with the agreement of the Secretary

of Veterans Affairs, provide care to persons covered by this subsection in facilities operated by the Secretary of Veterans Affairs

and determined by him to be available for this purpose on a reimbursable basis at rates approved by the President.

(c)(1) Funds appropriated to a military department, the Department of Homeland Security (with respect to the Coast Guard

when it is not operating as a service in the Navy), or the Department of Health and Human Services (with respect to the National

Oceanic and Atmospheric Administration and the Public Health

Service) may be used to provide medical and dental care to persons

entitled to such care by law or regulations, including the provision

of such care (other than elective private treatment) in private facilities for members of the uniformed services. If a private facility

or health care provider providing care under this subsection is a

health care provider under the Civilian Health and Medical Program of the Uniformed Services, the Secretary of Defense, after

consultation with the other administering Secretaries, may by regulation require the private facility or health care provider to pro-
9 § 1074 CH. 55—MEDICAL AND DENTAL CARE

vide such care in accordance with the same payment rules (subject

to any modifications considered appropriate by the Secretary) as

apply under that program.

(2)(A) Subject to such exceptions as the Secretary of Defense

considers necessary, coverage for medical care for members of the

uniformed services under this subsection, and standards with respect to timely access to such care, shall be comparable to coverage

for medical care and standards for timely access to such care under

the managed care option of the TRICARE program known as

TRICARE Prime.

(B) The Secretary of Defense shall enter into arrangements

with contractors under the TRICARE program or with other appropriate contractors for the timely and efficient processing of claims

under this subsection.

(C) The Secretary of Defense shall consult with the other administering Secretaries in the administration of this paragraph.

(3)(A) A member of the uniformed services described in subparagraph (B) may not be required to receive routine primary medical care at a military medical treatment facility.

(B) A member referred to in subparagraph (A) is a member of

the uniformed services on active duty who is entitled to medical

care under this subsection and who—

(i) receives a duty assignment described in subparagraph

(C); and

(ii) pursuant to the assignment of such duty, resides at a

location that is more than 50 miles, or approximately one hour

of driving time, from the nearest military medical treatment

facility adequate to provide the needed care.

(C) A duty assignment referred to in subparagraph (B) means

any of the following:

(i) Permanent duty as a recruiter.

(ii) Permanent duty at an educational institution to instruct, administer a program of instruction, or provide administrative services in support of a program of instruction for the

Reserve Officers’ Training Corps.

(iii) Permanent duty as a full-time adviser to a unit of a

reserve component.

(iv) Any other permanent duty designated by the Secretary

concerned for purposes of this paragraph.

(d)(1) For the purposes of this chapter, a member of a reserve

component of the armed forces who is issued a delayed-effectivedate active-duty order, or is covered by such an order, shall be

treated as being on active duty for a period of more than 30 days

beginning on the later of the date that is—

(A) the date of the issuance of such order; or

(B) 90 days before the date on which the period of active

duty is to commence under such order for that member.

(2) In this subsection, the term ‘‘delayed-effective-date activeduty order’’ means an order to active duty for a period of more than

30 days in support of a contingency operation under a provision of

law referred to in section 101(a)(13)(B) of this title that provides for

active-duty service to begin under such order on a date after the

date of the issuance of the order.
§ 1074a CH. 55—MEDICAL AND DENTAL CARE 10

(3) This subsection shall cease to be effective on December 31,

2004.

(Added P.L. 85–861, § 1(25)(B), Sept. 2, 1958, 72 Stat. 1446; amended P.L. 89–614, § 2(2), Sept.

30, 1966, 80 Stat. 862; P.L. 96–513, § 511(36), (37), Dec. 12, 1980, 94 Stat. 2923; P.L. 98–525,

§ 1401(e), Oct. 19, 1984, 98 Stat. 2616; P.L. 98–557, § 19(3), Oct. 30, 1984, 98 Stat. 2869; P.L.

101–189, §§ 729, 1621(a)(2), Nov. 29, 1989, 103 Stat. 1481, 1603; P.L. 101–510, § 1484(j)(1), Nov.

5, 1990, 104 Stat. 1718; P.L. 104–106, § 723, Feb. 10, 1996, 110 Stat. 377; P.L. 104–201, § 725(d),

Sept. 23, 1996, 110 Stat. 2596; P.L. 105–85, § 731(a), Nov. 18, 1997, 111 Stat. 1810; P.L. 106–

398, § 1[§ 722(a)(1)], Oct. 30, 2000, 114 Stat. 1654, 1654A–185; P.L. 107–296, § 1704(b)(1), Nov.

25, 2002, 116 Stat. 2314; P.L. 108–106, § 1116, Nov. 6, 2003, 117 Stat. 1218; P.L. 108–136,

§§ 703, 708, Nov. 24, 2003, 117 Stat. 1527, 1530.)

§ 1074a. Medical and dental care: members on duty other

than active duty for a period of more than 30 days

(a) Under joint regulations prescribed by the administering

Secretaries, the following persons are entitled to the benefits described in subsection (b):

(1) Each member of a uniformed service who incurs or aggravates an injury, illness, or disease in the line of duty while

performing—

(A) active duty for a period of 30 days or less;

(B) inactive-duty training; or

(C) service on funeral honors duty under section 12503

of this title or section 115 of title 32.

(2) Each member of a uniformed service who incurs or aggravates an injury, illness, or disease while traveling directly

to or from the place at which that member is to perform or has

performed—

(A) active duty for a period of 30 days or less;

(B) inactive-duty training; or

(C) service on funeral honors duty under section 12503

of this title or section 115 of title 32.

(3) Each member of the armed forces who incurs or aggravates an injury, illness, or disease in the line of duty while remaining overnight immediately before the commencement of

inactive-duty training, or while remaining overnight, between

successive periods of inactive-duty training, at or in the vicinity of the site of the inactive-duty training.

(4) Each member of the armed forces who incurs or aggravates an injury, illness, or disease in the line of duty while remaining overnight immediately before serving on funeral honors duty under section 12503 of this title or section 115 of title

32 at or in the vicinity of the place at which the member was

to so serve, if the place is outside reasonable commuting distance from the member’s residence.

(b) A person described in subsection (a) is entitled to—

(1) the medical and dental care appropriate for the treatment of the injury, illness, or disease of that person until the

resulting disability cannot be materially improved by further

hospitalization or treatment; and

(2) subsistence during hospitalization.

(c) A member is not entitled to benefits under subsection (b) if

the injury, illness, or disease, or aggravation of an injury, illness,

or disease described in subsection (a)(2), is the result of the gross

negligence or misconduct of the member.

(d)(1) The Secretary of the Army shall provide to members of

the Selected Reserve of the Army who are assigned to units sched-
11 § 1074d CH. 55—MEDICAL AND DENTAL CARE

uled for deployment within 75 days after mobilization the following

medical and dental services:

(A) An annual medical screening.

(B) For members who are over 40 years of age, a full physical examination not less often than once every two years.

(C) An annual dental screening.

(D) The dental care identified in an annual dental screening as required to ensure that a member meets the dental

standards required for deployment in the event of mobilization.

(2) The services provided under this subsection shall be provided at no cost to the member.

(e)(1) A member of a uniformed service on active duty for

health care or recuperation reasons, as described in paragraph (2),

is entitled to medical and dental care on the same basis and to the

same extent as members covered by section 1074(a) of this title

while the member remains on active duty.

(2) Paragraph (1) applies to a member described in paragraph

(1) or (2) of subsection (a) who, while being treated for (or recovering from) an injury, illness, or disease incurred or aggravated in

the line of duty, is continued on active duty pursuant to a modification or extension of orders, or is ordered to active duty, so as to result in active duty for a period of more than 30 days.

(f)(1) At any time after the Secretary concerned notifies members of the Ready Reserve that the members are to be called or ordered to active duty for a period of more than 30 days, the administering Secretaries may provide to each such member any medical

and dental screening and care that is necessary to ensure that the

member meets the applicable medical and dental standards for deployment.

(2) The notification to members of the Ready Reserve described

in paragraph (1) shall include notice that the members are eligible

for screening and care under this section.

(3) A member provided medical or dental screening or care

under paragraph (1) may not be charged for the screening or care.

(Added P.L. 98–94, § 1012(a)(1), Sept. 24, 1983, 97 Stat. 664; amended P.L. 98–525, § 631(a), Oct.

19, 1984, 98 Stat. 2542; P.L. 98–557, § 19(4), Oct. 30, 1984, 98 Stat. 2869; P.L. 99–145,

§ 1303(a)(7), Nov. 8, 1985, 99 Stat. 738; revised in its entirety P.L. 99–661, § 604(a)(1), Nov. 14,

1986, 100 Stat. 3874; P.L. 104–106, § 702(a), 704(a), Feb. 10, 1996, 110 Stat. 371, 372; P.L. 105–

85, § 513(a), Nov. 18, 1997, 111 Stat. 1730; P.L. 106–65, §§ 578(i)(1), 705(b), Oct. 5, 1999, 113

Stat. 629, 683; P.L. 107–107, § 513(a), Dec. 28, 2001, 115 Stat. 1093; P.L. 108–106, § 1114, Nov.

6, 2003, 117 Stat. 1216; P.L. 108–136, § 701, Nov. 24, 2003, 117 Stat. 1525.)

ø§ 1074b. Repealed. P.L. 107–107, 736(c)(1), Dec. 28, 2001, 115

Stat. 1173¿

§ 1074c. Medical care: authority to provide a wig

A person entitled to medical care under this chapter who has

alopecia resulting from the treatment of a malignant disease may

be furnished a wig if the person has not previously been furnished

one at the expense of the United States.

(Added as § 1074b P.L. 98–525, § 1401(e)(2), Oct. 19, 1984, 98 Stat. 2616; redesignated § 1074c

P.L. 102–190, § 640(a)(1), Dec. 5, 1991, 105 Stat. 1385.)

§ 1074d. Certain primary and preventive health care

services

(a) SERVICES AVAILABLE.—(1) Female members and former

members of the uniformed services entitled to medical care under
§ 1074e CH. 55—MEDICAL AND DENTAL CARE 12

section 1074 or 1074a of this title shall also be entitled to primary

and preventive health care services for women as part of such medical care.

(2) Male members and former members of the uniformed services entitled to medical care under section 1074 or 1074a of this

title shall also be entitled to preventive health care screening for

colon or prostate cancer at such intervals and using such screening

methods as the administering Secretaries consider appropriate.

(b) DEFINITION.—In this section, the term ‘‘primary and preventive health care services for women’’ means health care services,

including related counseling services, provided to women with respect to the following:

(1) Papanicolaou tests (pap smear).

(2) Breast examinations and mammography.

(3) Comprehensive obstetrical and gynecological care, including care related to pregnancy and the prevention of

pregnancy.

(4) Infertility and sexually transmitted diseases, including

prevention.

(5) Menopause, including hormone replacement therapy

and counseling regarding the benefits and risks of hormone replacement therapy.

(6) Physical or psychological conditions arising out of acts

of sexual violence.

(7) Gynecological cancers.

(8) Colon cancer screening, at the intervals and using the

screening methods prescribed under subsection (a)(2).

(Added P.L. 103–160, § 701(a)(1), Nov. 30, 1993, 107 Stat. 1685; amended P.L. 104–201,

§ 701(a)(1), (2)(A), Sept. 23, 1996, 110 Stat. 2587.)

§ 1074e. Medical care: certain Reserves who served in Southwest Asia during the Persian Gulf Conflict

(a) ENTITLEMENT TO MEDICAL CARE.—A member of the armed

forces described in subsection (b) is entitled to medical care for a

qualifying Persian Gulf symptom or illness to the same extent and

under the same conditions (other than the requirement that the

member be on active duty) as a member of a uniformed service who

is entitled to such care under section 1074(a) of this title.

(b) COVERED MEMBERS.—Subsection (a) applies to a member of

a reserve component who—

(1) is a Persian Gulf veteran;

(2) has a qualifying Persian Gulf symptom or illness; and

(3) is not otherwise entitled to medical care for such symptom or illness under this chapter and is not otherwise eligible

for hospital care and medical services for such symptom or illness under section 1710 of title 38.

(c) DEFINITIONS.—In this section:

(1) The term ‘‘Persian Gulf veteran’’ means a member of

the armed forces who served on active duty in the Southwest

Asia theater of operations during the Persian Gulf Conflict.

(2) The term ‘‘qualifying Persian Gulf symptom or illness’’

means, with respect to a member described in subsection (b),

a symptom or illness—

(A) that the member registered before September 1,

1997, in the Comprehensive Clinical Evaluation Program
13 § 1074g CH. 55—MEDICAL AND DENTAL CARE

of the Department of Defense and that is presumed under

section 721(d) of the National Defense Authorization Act

for Fiscal Year 1995 (10 U.S.C. 1074 note) to be a result

of service in the Southwest Asia theater of operations during the Persian Gulf Conflict; or

(B) that the member registered before September 1,

1997, in the Persian Gulf War Veterans Health Registry

maintained by the Department of Veterans Affairs pursuant to section 702 of the Persian Gulf War Veterans’

Health Status Act (38 U.S.C. 527 note).

(Added P.L. 105–85, § 764(a), Nov. 18, 1997, 111 Stat. 1825.)

§ 1074f. Medical tracking system for members deployed overseas

(a) SYSTEM REQUIRED.—The Secretary of Defense shall establish a system to assess the medical condition of members of the

armed forces (including members of the reserve components) who

are deployed outside the United States or its territories or possessions as part of a contingency operation (including a humanitarian

operation, peacekeeping operation, or similar operation) or combat

operation.

(b) ELEMENTS OF SYSTEM.—The system described in subsection

(a) shall include the use of predeployment medical examinations

and postdeployment medical examinations (including an assessment of mental health and the drawing of blood samples) to accurately record the medical condition of members before their deployment and any changes in their medical condition during the course

of their deployment. The postdeployment examination shall be conducted when the member is redeployed or otherwise leaves an area

in which the system is in operation (or as soon as possible thereafter).

(c) RECORDKEEPING.—The results of all medical examinations

conducted under the system, records of all health care services (including immunizations) received by members described in subsection (a) in anticipation of their deployment or during the course

of their deployment, and records of events occurring in the deployment area that may affect the health of such members shall be retained and maintained in a centralized location to improve future

access to the records.

(d) QUALITY ASSURANCE.—The Secretary of Defense shall establish a quality assurance program to evaluate the success of the

system in ensuring that members described in subsection (a) receive predeployment medical examinations and postdeployment

medical examinations and that the recordkeeping requirements

with respect to the system are met.

(Added P.L. 105–85, § 765(a), Nov. 18, 1997, 111 Stat. 1826.)

§ 1074g. Pharmacy benefits program

(a) PHARMACY BENEFITS.—(1) The Secretary of Defense, after

consulting with the other administering Secretaries, shall establish

an effective, efficient, integrated pharmacy benefits program under

this chapter (hereinafter in this section referred to as the ‘‘pharmacy benefits program’’).

(2)(A) The pharmacy benefits program shall include a uniform

formulary of pharmaceutical agents, which shall assure the avail-
§ 1074g CH. 55—MEDICAL AND DENTAL CARE 14

ability of pharmaceutical agents in the complete range of therapeutic classes. The selection for inclusion on the uniform formulary

of particular pharmaceutical agents in each therapeutic class shall

be based on the relative clinical and cost effectiveness of the agents

in such class.

(B) In considering the relative clinical effectiveness of agents

under subparagraph (A), the Secretary shall presume inclusion in

a therapeutic class of a pharmaceutical agent, unless the Pharmacy

and Therapeutics Committee established under subsection (b) finds

that a pharmaceutical agent does not have a significant, clinically

meaningful therapeutic advantage in terms of safety, effectiveness,

or clinical outcome over the other drugs included on the uniform

formulary.

(C) In considering the relative cost effectiveness of agents

under subparagraph (A), the Secretary shall rely on the evaluation

by the Pharmacy and Therapeutics Committee of the costs of

agents in a therapeutic class in relation to the safety, effectiveness,

and clinical outcomes of such agents.

(D) The Secretary shall establish procedures for the selection

of particular pharmaceutical agents for the uniform formulary.

Such procedures shall be established so as best to accomplish, in

the judgment of the Secretary, the objectives set forth in paragraph

(1). No pharmaceutical agent may be excluded from the uniform

formulary except upon the recommendation of the Pharmacy and

Therapeutics Committee. The Secretary shall begin to implement

the uniform formulary not later than October 1, 2000.

(E) Pharmaceutical agents included on the uniform formulary

shall be available to eligible covered beneficiaries through—

(i) facilities of the uniformed services, consistent with the

scope of health care services offered in such facilities;

(ii) retail pharmacies designated or eligible under the

TRICARE program or the Civilian Health and Medical Program of the Uniformed Services to provide pharmaceutical

agents to covered beneficiaries; or

(iii) the national mail-order pharmacy program.

(3) The pharmacy benefits program shall assure the availability of clinically appropriate pharmaceutical agents to members

of the armed forces, including, where appropriate, agents not included on the uniform formulary described in paragraph (2).

(4) The pharmacy benefits program may provide that prior authorization be required for certain pharmaceutical agents to assure

that the use of such agents is clinically appropriate.

(5) The pharmacy benefits program shall assure the availability to eligible covered beneficiaries of pharmaceutical agents

not included on the uniform formulary. Such pharmaceutical

agents shall be available through at least one of the means described in paragraph (2)(E) under terms and conditions that may

include cost sharing by the eligible covered beneficiary in addition

to any such cost sharing applicable to agents on the uniform formulary.

(6) The Secretary, in the regulations prescribed under subsection (g), may establish cost sharing requirements (which may be

established as a percentage or fixed dollar amount) under the pharmacy benefits program for generic, formulary, and nonformulary

agents. For nonformulary agents, cost sharing shall be consistent
15 § 1074g CH. 55—MEDICAL AND DENTAL CARE

with common industry practice and not in excess of amounts generally comparable to 20 percent for beneficiaries covered by section

1079 of this title or 25 percent for beneficiaries covered by section

1086 of this title.

(7) The Secretary shall establish procedures for eligible covered

beneficiaries to receive pharmaceutical agents that are not included

on the uniform formulary but that are considered to be clinically

necessary. Such procedures shall include peer review procedures

under which the Secretary may determine that there is a clinical

justification for the use of a pharmaceutical agent that is not on

the uniform formulary, in which case the pharmaceutical agent

shall be provided under the same terms and conditions as an agent

on the uniform formulary. Such procedures shall also include an

expeditious appeals process for an eligible covered beneficiary, or a

network or uniformed provider on behalf of the beneficiary, to establish clinical justification for the use of a pharmaceutical agent

that is not on the uniform formulary.

(8) In carrying out this subsection, the Secretary shall ensure

that an eligible covered beneficiary may continue to receive coverage for any maintenance pharmaceutical that is not on the uniform formulary and that was prescribed for the beneficiary before

October 5, 1999, and stabilized the medical condition of the beneficiary.

(b) ESTABLISHMENT OF COMMITTEE.—(1) The Secretary of Defense shall, in consultation with the Secretaries of the military departments, establish a Pharmacy and Therapeutics Committee for

the purpose of developing the uniform formulary of pharmaceutical

agents required by subsection (a), reviewing such formulary on a

periodic basis, and making additional recommendations regarding

the formulary as the committee determines necessary and appropriate. The committee shall include representatives of pharmacies

of the uniformed services facilities and representatives of providers

in facilities of the uniformed services. Committee members shall

have expertise in treating the medical needs of the populations

served through such entities and in the range of pharmaceutical

and biological medicines available for treating such populations.

The committee shall function under procedures established by the

Secretary under the regulations prescribed under subsection (g).

(2) Not later than 90 days after the establishment of the Pharmacy and Therapeutics Committee by the Secretary, the committee

shall convene to design a proposed uniform formulary for submission to the Secretary. After such 90-day period, the committee shall

meet at least quarterly and shall, during meetings, consider for inclusion on the uniform formulary under the standards established

in subsection (a) any drugs newly approved by the Food and Drug

Administration.

(c) ADVISORY PANEL.—(1) Concurrent with the establishment of

the Pharmacy and Therapeutics Committee under subsection (b),

the Secretary shall establish a Uniform Formulary Beneficiary Advisory Panel to review and comment on the development of the uniform formulary. The Secretary shall consider the comments of the

panel before implementing the uniform formulary or implementing

changes to the uniform formulary.
§ 1074g CH. 55—MEDICAL AND DENTAL CARE 16

(2) The Secretary shall determine the size and membership of

the panel established under paragraph (1), which shall include

members that represent—

(A) nongovernmental organizations and associations that

represent the views and interests of a large number of eligible

covered beneficiaries;

(B) contractors responsible for the TRICARE retail pharmacy program;

(C) contractors responsible for the national mail-order

pharmacy program; and

(D) TRICARE network providers.

(d) PROCEDURES.—(1) In the operation of the pharmacy benefits program under subsection (a), the Secretary of Defense shall

assure through management and new contractual arrangements

that financial resources are aligned such that the cost of prescriptions is borne by the organization that is financially responsible for

the health care of the eligible covered beneficiary.

(2) Effective not later than April 5, 2000, the Secretary shall

use a modification to the bid price adjustment methodology in the

current managed care support contracts to ensure equitable and

timely reimbursement to the TRICARE managed care support contractors for pharmaceutical products delivered in the nonmilitary

environments. The methodology shall take into account the ‘‘atrisk’’ nature of the contracts as well as managed care support contractor pharmacy costs attributable to changes to pharmacy service

or formulary management at military medical treatment facilities,

and other military activities and policies that affect costs of pharmacy benefits provided through the Civilian Health and Medical

Program of the Uniformed Services. The methodology shall also account for military treatment facility costs attributable to the delivery of pharmaceutical products in the military facility environment

which were prescribed by a network provider.

(e) PHARMACY DATA TRANSACTION SERVICE.—The Secretary of

Defense shall implement the use of the Pharmacy Data Transaction Service in all fixed facilities of the uniformed services under

the jurisdiction of the Secretary, in the TRICARE retail pharmacy

program, and in the national mail-order pharmacy program.

(f) DEFINITIONS.—In this section:

(1) The term ‘‘eligible covered beneficiary’’ means a covered

beneficiary for whom eligibility to receive pharmacy benefits

through the means described in subsection (a)(2)(E) is established under this chapter or another provision of law.

(2) The term ‘‘pharmaceutical agent’’ means drugs, biological products, and medical devices under the regulatory authority of the Food and Drug Administration.

(g) REGULATIONS.—The Secretary of Defense shall, after consultation with the other administering Secretaries, prescribe regulations to carry out this section.

(Added P.L. 106–65, § 701(a)(1), Oct. 5, 1999, 113 Stat. 677; amended P.L. 106–398,

§ 1[§ 1087(a)(5)], Oct. 30, 2000, 114 Stat. 1654, 1654A–290; P.L. 107–107, § 1048(c)(4), Dec. 28,

2001, 115 Stat. 1226; P.L. 108–136, § 725, Nov. 24, 2003, 117 Stat. 1535.)
17 § 1074j CH. 55—MEDICAL AND DENTAL CARE

§ 1074h. Medical and dental care: medal of honor recipients;

dependents

(a) MEDAL OF HONOR RECIPIENTS.—A former member of the

armed forces who is a Medal of Honor recipient and who is not otherwise entitled to medical and dental benefits under this chapter

may, upon request, be given medical and dental care provided by

the administering Secretaries in the same manner as if entitled to

retired pay.

(b) IMMEDIATE DEPENDENTS.—A person who is an immediate

dependent of a Medal of Honor recipient and who is not otherwise

entitled to medical and dental benefits under this chapter may,

upon request, be given medical and dental care provided by the administering Secretaries in the same manner as if the Medal of

Honor recipient were, or (if deceased) was at the time of death, entitled to retired pay.

(c) DEFINITIONS.—In this section:

(1) The term ‘‘Medal of Honor recipient’’ means a person

who has been awarded a medal of honor under section 3741,

6241, or 8741 of this title or section 491 of title 14.

(2) The term ‘‘immediate dependent’’ means a dependent

described in subparagraph (A), (B), (C), or (D) of section

1072(2) of this title.

(Added P.L. 106–398, § 1[§ 706(a)(1)], Oct. 30, 2000, 114 Stat. 1654, 1654A–175.)

§ 1074i. Reimbursement for certain travel expenses

(a) IN GENERAL.—In any case in which a covered beneficiary

is referred by a primary care physician to a specialty care provider

who provides services more than 100 miles from the location in

which the primary care provider provides services to the covered

beneficiary, the Secretary shall provide reimbursement for reasonable travel expenses for the covered beneficiary and, when accompaniment by an adult is necessary, for a parent or guardian of the

covered beneficiary or another member of the covered beneficiary’s

family who is at least 21 years of age.

(b) DEFINITIONS.—In this section:

(1) The term ‘‘specialty care provider’’ includes a dental

specialist.

(2) The term ‘‘dental specialist’’ means an oral surgeon, orthodontist, prosthodontist, periodontist, endodontist, or pediatric dentist, and includes such other providers of dental care

and services as determined appropriate by the Secretary of Defense.

(Added P.L. 106–398, § 1[§ 758(a)], Oct. 30, 2000, 114 Stat. 1654, 1654A–199; amended P.L. 107–

107, § 706, Dec. 28, 2001, 115 Stat. 1163; P.L. 108–136, § 712, Nov. 24, 2003, 117 Stat. 1530.)

§ 1074j. Sub-acute care program

(a) ESTABLISHMENT.—The Secretary of Defense shall establish

an effective, efficient, and integrated sub-acute care benefits program under this chapter (hereinafter referred to in this section as

the ‘‘program’’). Except as otherwise provided in this section, the

types of health care authorized under the program shall be the

same as those provided under section 1079 of this title. The Secretary, after consultation with the other administering Secretaries,

shall promulgate regulations to carry out this section.
§ 1074k CH. 55—MEDICAL AND DENTAL CARE 18

2Subsection (b) of section 1075 was added by section 8146(a) of P.L. 108–87 (117 Stat. 1109).

Section 8146(b) of P.L. 108–87, as amended by section 1112(b) of P.L. 108–106 (117 Stat. 1215),

provides:

(b) EFFECTIVE DATE.—(1) Subsection (b)(2) of section 1075 of title 10, United States Code, as

added by subsection (a), shall apply with respect to any period of hospitalization on or after September 11, 2001, because of an injury covered by that subsection that is incurred on or after

that date.

(2) The Secretary concerned (as defined in section 101 of title 37, United States Code) shall

take such action as necessary to implement paragraph (1), including—

(A) refunding any amount previously paid under section 1075 of title 10, United States

Code, by a person who, by reason of paragraph (1), is not required to make such payment;

and

(B) waiving recovery of any unpaid amount for which a person has previously been

charged under that section and which that person, by reason of paragraph (1), is not required to pay.

(b) BENEFITS.—(1) The program shall include a uniform skilled

nursing facility benefit that shall be provided in the manner and

under the conditions described in section 1861 (h) and (i) of the Social Security Act (42 U.S.C. 1395x (h) and (i)), except that the limitation on the number of days of coverage under section 1812 (a)

and (b) of such Act (42 U.S.C. 1395d (a) and (b)) shall not be applicable under the program. Skilled nursing facility care for each spell

of illness shall continue to be provided for as long as medically necessary and appropriate.

(2) In this subsection:

(A) The term ‘‘skilled nursing facility’’ has the meaning

given such term in section 1819(a) of the Social Security Act

(42 U.S.C. 1395i–3(a)).

(B) The term ‘‘spell of illness’’ has the meaning given such

term in section 1861(a) of such Act (42 U.S.C. 1395x(a)).

(3) The program shall include a comprehensive, part-time or

intermittent home health care benefit that shall be provided in the

manner and under the conditions described in section 1861(m) of

the Social Security Act (42 U.S.C. 1395x(m)).

(Added P.L. 107–107, § 701(a)(1), Dec. 28, 2001, 115 Stat. 1158.)

§ 1074k. Long-term care insurance

Provisions regarding long-term care insurance for members

and certain former members of the uniformed services and their

families are set forth in chapter 90 of title 5.

(Added P.L. 107–107, § 701(f)(1), Dec. 28, 2001, 115 Stat. 1161.)

§ 1075. Officers and certain enlisted members: subsistence

charges

(a) IN GENERAL.—When an officer or former officer of a uniformed service, or an enlisted member of a uniformed service entitled to basic allowance for subsistence, is hospitalized under section

1074 of this title, he shall pay an amount equal to the part of the

charge prescribed under section 1078 of this title that is attributable to subsistence.

(b) EXCEPTIONS.—Subsection (a) shall not apply to any of the

following:

(1) An enlisted member, or former enlisted member, of a

uniformed service who is entitled to retired or retainer pay or

equivalent pay.

(2) 2 An officer or former officer of a uniformed service, or

an enlisted member or former enlisted member of a uniformed

service not described in paragraph (1), who is hospitalized
19 § 1076 CH. 55—MEDICAL AND DENTAL CARE

under section 1074 because of an injury incurred (as determined under criteria prescribed by the Secretary of Defense)—

(A) as a direct result of armed conflict;

(B) while engaged in hazardous service;

(C) in the performance of duty under conditions simulating war; or

(D) through an instrumentality of war.

(Added P.L. 85–861, § 1(25)(B), Sept. 2, 1958, 72 Stat. 1447; amended P.L. 97–22, § 10(b)(2), July

10, 1981, 95 Stat. 137; P.L. 108–87, § 8146(a), Sept. 30, 2003, 117 Stat. 1109; P.L. 108–106,

§ 1112(a), Nov. 6, 2003, 117 Stat. 1215.)

§ 1076. Medical and dental care for dependents: general rule

(a)(1) A dependent described in paragraph (2) is entitled, upon

request, to the medical and dental care prescribed by section 1077

of this title in facilities of the uniformed services, subject to the

availability of space and facilities and the capabilities of the medical and dental staff.

(2) A dependent referred to in paragraph (1) is a dependent of

a member of a uniformed service described in one of the following

subparagraphs:

(A) A member who is on active duty for a period of more

than 30 days or died while on that duty.

(B) A member who died from an injury, illness, or disease

incurred or aggravated—

(i) while the member was on active duty under a call

or order to active duty of 30 days or less, on active duty

for training, or on inactive-duty training; or

(ii) while the member was traveling to or from the

place at which the member was to perform, or had performed, such active duty, active duty for training, or inactive-duty training.

(C) A member who died from an injury, illness, or disease

incurred or aggravated in the line of duty while the member

remained overnight immediately before the commencement of

inactive-duty training, or while the member remained overnight between successive periods of inactive-duty training, at

or in the vicinity of the site of the inactive-duty training.

(D) A member on active duty who is entitled to benefits

under subsection (e) of section 1074a of this title by reason of

paragraph (1), (2), or (3) of subsection (a) of such section.

(E) A member who died from an injury, illness, or disease

incurred or aggravated while the member—

(i) was serving on funeral honors duty under section

12503 of this title or section 115 of title 32;

(ii) was traveling to or from the place at which the

member was to so serve; or

(iii) remained overnight at or in the vicinity of that

place immediately before so serving, if the place is outside

reasonable commuting distance from the member’s residence.

(b) Under regulations to be prescribed jointly by the administering Secretaries, a dependent of a member or former member—

(1) who is, or (if deceased) was at the time of his death,

entitled to retired or retainer pay or equivalent pay; or
§ 1076 CH. 55—MEDICAL AND DENTAL CARE 20

(2) who died before attaining age 60 and at the time of his

death would have been eligible for retired pay under chapter

1223 of this title (or under chapter 67 of this title as in effect

before December 1, 1994) but for the fact that he was under

60 years of age;

may, upon request, be given the medical and dental care prescribed

by section 1077 of this title in facilities of the uniformed services,

subject to the availability of space and facilities and the capabilities

of the medical and dental staff, except that a dependent of a member or former member described in paragraph (2) may not be given

such medical or dental care until the date on which such member

or former member would have attained age 60.

(c) A determination by the medical or dental officer in charge,

or the contract surgeon in charge, or his designee, as to the availability of space and facilities and to the capabilities of the medical

and dental staff is conclusive. Care under this section may not be

permitted to interfere with the primary mission of those facilities.

(d) To utilize more effectively the medical and dental facilities

of the uniformed services, the administering Secretaries shall prescribe joint regulations to assure that dependents entitled to medical or dental care under this section will not be denied equal opportunity for that care because the facility concerned is that of a

uniformed service other than that of the member.

(e)(1) Subject to paragraph (3), the administering Secretary

shall furnish an abused dependent of a former member of a uniformed service described in paragraph (4), during that period that

the abused dependent is in receipt of transitional compensation

under section 1059 of this title, with medical and dental care, including mental health services, in facilities of the uniformed services in accordance with the same eligibility and benefits as were

applicable for that abused dependent during the period of active

service of the former member.

(2) Subject to paragraph (3), upon request of any dependent of

a former member of a uniformed service punished for an abuse described in paragraph (4), the administering Secretary for such uniformed service may furnish medical care in facilities of the uniformed services to the dependent for the treatment of any adverse

health condition resulting from such dependent’s knowledge of (A)

the abuse, or (B) any injury or illness suffered by the abused person as a result of such abuse.

(3) Medical and dental care furnished to a dependent of a

former member of the uniformed services in facilities of the uniformed services under paragraph (1) or (2)—

(A) shall be limited to the health care prescribed by section

1077 of this title; and

(B) shall be subject to the availability of space and facilities and the capabilities of the medical and dental staff.

(4)(A) A former member of a uniformed service referred to in

paragraph (1) is a member who—

(i) received a dishonorable or bad-conduct discharge or was

dismissed from a uniformed service as a result of a court-martial conviction for an offense, under either military or civil law,

involving abuse of a dependent of the member; or

(ii) was administratively discharged from a uniformed

service as a result of such an offense.
21 § 1076a CH. 55—MEDICAL AND DENTAL CARE

(B) A determination of whether an offense involved abuse of a

dependent of the member shall be made in accordance with regulations prescribed by the administering Secretary for such uniformed

service.

(f)(1) The administering Secretaries shall furnish an eligible

dependent a physical examination that is required by a school in

connection with the enrollment of the dependent as a student in

that school.

(2) A dependent is eligible for a physical examination under

paragraph (1) if the dependent—

(A) is entitled to receive medical care under subsection (a)

or is authorized to receive medical care under subsection (b);

and

(B) is at least 5 years of age and less than 12 years of age.

(3) Nothing in paragraph (2) may be construed to prohibit the

furnishing of a school-required physical examination to any dependent who, except for not satisfying the age requirement under

that paragraph, would otherwise be eligible for a physical examination required to be furnished under this subsection.

(Added P.L. 85–861, § 1(25)(B), Sept. 2, 1958, 72 Stat. 1447; amended P.L. 89–614, § 2(3), Sept.

30, 1966, 80 Stat. 862; P.L. 95–397, § 301, Sept. 30, 1978, 92 Stat. 849; P.L. 96–513, § 511(36),

Dec. 12, 1980, 94 Stat. 2923; P.L. 97–252, § 1004(b), Sept. 8, 1982, 96 Stat. 737; P.L. 98–557,

§ 19(5), Oct. 30, 1984, 98 Stat. 2869; P.L. 99–145, § 652(a), Nov. 8, 1985, 99 Stat. 656; P.L. 99–

661, §§ 604(f)(1)(C), 652(c), Nov. 14, 1986, 100 Stat. 3877, 3889; P.L. 100–456, § 651(a), Sept. 29,

1988, 102 Stat. 1990; P.L. 101–189, §§ 653(a)(4), 731(c)(1), Nov. 29, 1989, 103 Stat. 1462, 1482;

P.L. 103–337, §§ 704(a), (b), 1671(c)(7)(A), 108 Stat. 2798, 3014; P.L. 104–106, § § 703,

1501(c)(11), Feb. 10, 1996, 110 Stat. 372, 499; P.L. 105–85, § 513(b), Nov. 18, 1997, 111 Stat.

1730; P.L. 105–261, § 732, Oct. 17, 1998, 112 Stat. 2071; P.L. 106–65, §§ 578(i)(2), 705(c), Oct.

5, 1999, 113 Stat. 629, 684; P.L. 106–398, § 1[§ 703], Oct. 30, 2000, 114 Stat. 1654, 1654A–174;

P.L. 107–107, § 513(a), Dec. 28, 2001, 115 Stat. 1093.)

§ 1076a. TRICARE dental program

(a) ESTABLISHMENT OF DENTAL PLANS.—The Secretary of Defense may establish, and in the case of the dental plan described

in paragraph (1) shall establish, the following voluntary enrollment

dental plans:

(1) PLAN FOR SELECTED RESERVE AND INDIVIDUAL READY

RESERVE.—A dental insurance plan for members of the Selected Reserve of the Ready Reserve and for members of the

Individual Ready Reserve described in subsection 10144(b) of

this title.

(2) PLAN FOR OTHER RESERVES.—A dental insurance plan

for members of the Individual Ready Reserve not eligible to enroll in the plan established under paragraph (1).

(3) PLAN FOR ACTIVE DUTY DEPENDENTS.—Dental benefits

plans for eligible dependents of members of the uniformed

services who are on active duty for a period of more than 30

days.

(4) PLAN FOR READY RESERVE DEPENDENTS.—A dental benefits plan for eligible dependents of members of the Ready Reserve of the reserve components who are not on active duty for

more than 30 days.

(b) ADMINISTRATION OF PLANS.—The plans established under

this section shall be administered under regulations prescribed by

the Secretary of Defense in consultation with the other administering Secretaries.

(c) CARE AVAILABLE UNDER PLANS.—Dental plans established

under subsection (a) may provide for the following dental care:
§ 1076a CH. 55—MEDICAL AND DENTAL CARE 22

(1) Diagnostic, oral examination, and preventive services

and palliative emergency care.

(2) Basic restorative services of amalgam and composite

restorations, stainless steel crowns for primary teeth, and dental appliance repairs.

(3) Orthodontic services, crowns, gold fillings, bridges, complete or partial dentures, and such other services as the Secretary of Defense considers to be appropriate.

(d) PREMIUMS.— (1) PREMIUM SHARING PLANS.—(A) The dental insurance

plan established under subsection (a)(1) and the dental benefits plans established under subsection (a)(3) are premium

sharing plans.

(B) Members enrolled in a premium sharing plan for themselves or for their dependents shall be required to pay a share

of the premium charged for the benefits provided under the

plan. The member’s share of the premium charge may not exceed $20 per month for the enrollment.

(C) Effective as of January 1 of each year, the amount of

the premium required under subparagraph (A) shall be increased by the percent equal to the lesser of—

(i) the percent by which the rates of basic pay of members of the uniformed services are increased on such date;

or

(ii) the sum of one-half percent and the percent computed under section 5303(a) of title 5 for the increase in

rates of basic pay for statutory pay systems for pay periods

beginning on or after such date.

(D) The Secretary of Defense may reduce the monthly premium required to be paid under paragraph (1) in the case of

enlisted members in pay grade E–1, E–2, E–3, or E–4 if the

Secretary determines that such a reduction is appropriate to

assist such members to participate in a dental plan referred to

in subparagraph (A).

(2) FULL PREMIUM PLANS.—(A) The dental insurance plan

established under subsection (a)(2) and the dental benefits

plan established under subsection (a)(4) are full premium

plans.

(B) Members enrolled in a full premium plan for themselves or for their dependents shall be required to pay the entire premium charged for the benefits provided under the plan.

(3) PAYMENT PROCEDURES.—A member’s share of the premium for a plan established under subsection (a) may be paid

by deductions from the basic pay of the member and from compensation paid under section 206 of title 37, as the case may

be. The regulations prescribed under subsection (b) shall specify the procedures for payment of the premiums by enrollees

who do not receive such pay.

(e) COPAYMENTS UNDER PREMIUM SHARING PLANS.—A member

or dependent who receives dental care under a premium sharing

plan referred to in subsection (d)(1) shall—

(1) in the case of care described in subsection (c)(1), pay no

charge for the care;

(2) in the case of care described in subsection (c)(2), pay 20

percent of the charges for the care; and
23 § 1076a CH. 55—MEDICAL AND DENTAL CARE

(3) in the case of care described in subsection (c)(3), pay a

percentage of the charges for the care that is determined appropriate by the Secretary of Defense, after consultation with

the other administering Secretaries.

(f) TRANSFER OF MEMBERS.—If a member whose dependents

are enrolled in the plan established under subsection (a)(3) is

transferred to a duty station where dental care is provided to the

member’s eligible dependents under a program other than that

plan, the member may discontinue participation under the plan. If

the member is later transferred to a duty station where dental care

is not provided to such member’s eligible dependents except under

the plan established under subsection (a)(3), the member may reenroll the dependents in that plan.

(g) CARE OUTSIDE THE UNITED STATES.—The Secretary of Defense may exercise the authority provided under subsection (a) to

establish dental insurance plans and dental benefits plans for dental benefits provided outside the United States for the eligible

members and dependents of members of the uniformed services. In

the case of such an overseas dental plan, the Secretary may waive

or reduce any copayments required by subsection (e) to the extent

the Secretary determines appropriate for the effective and efficient

operation of the plan.

(h) WAIVER OF REQUIREMENTS FOR SURVIVING DEPENDENTS.— The Secretary of Defense may waive (in whole or in part) any requirements of a dental plan established under this section as the

Secretary determines necessary for the effective administration of

the plan for a dependent who is an eligible dependent described in

subsection (k)(2).

(i) AUTHORITY SUBJECT TO APPROPRIATIONS.—The authority of

the Secretary of Defense to enter into a contract under this section

for any fiscal year is subject to the availability of appropriations for

that purpose.

(j) LIMITATION ON REDUCTION OF BENEFITS.—The Secretary of

Defense may not reduce benefits provided under a plan established

under this section until—

(1) the Secretary provides notice of the Secretary’s intent

to reduce such benefits to the Committees on Armed Services

of the Senate and the House of Representatives; and

(2) one year has elapsed following the date of such notice.

(k) ELIGIBLE DEPENDENT DEFINED.—In this section, the term

‘‘eligible dependent’’—

(1) means a dependent described in subparagraph (A), (D),

or (I) of section 1072(2) of this title; and

(2) includes any such dependent of a member who dies

while on active duty for a period of more than 30 days or a

member of the Ready Reserve if, on the date of the death of

the member, the dependent is enrolled in a dental benefits

plan established under subsection (a) or is not enrolled in such

a plan by reason of a discontinuance of a former enrollment

under subsection (f), except that the term does not include the

dependent after the end of the three-year period beginning on

the date of the member’s death.

(Added P.L. 99–145, § 651(a), Nov. 8, 1985, 99 Stat. 655; amended P.L. 99–661, § 707 (a), (b),

Nov. 14, 1986, 100 Stat. 3905; P.L. 102–90, § 701, Dec. 5, 1991, 105 Stat. 1399; P.L. 102–484,

§ 701(a)–(e), Oct. 23, 1992, 106 Stat. 2430; P.L. 103–337, § 702(b), 703(a), 707(b), Oct. 5, 1994,

108 Stat. 2797, 2798, 2800; P.L. 105–85, § 732, Nov. 18, 1997, 111 Stat. 1812; P.L. 105–261,
§ 1076b CH. 55—MEDICAL AND DENTAL CARE 24

§ 701(a), (b), Oct. 17, 1998, 112 Stat. 2056; amended in its entirety P.L. 106–65, § 711(a), Oct.

5, 1999, 113 Stat. 685; P.L. 106–398, § 1[§ 704(a)], Oct. 30, 2000, 114 Stat. 1654, 1654A–174;

P.L. 107–314, § 703, Dec. 2, 2002, 116 Stat. 2584.)

§ 1076b. TRICARE program: coverage for members of the

Ready Reserve

(a) ELIGIBILITY.—Each member of the Selected Reserve of the

Ready Reserve and each member of the Individual Ready Reserve

described in section 10144(b) of this title is eligible, subject to subsection (h), to enroll in TRICARE and receive benefits under such

enrollment for any period that the member—

(1) is an eligible unemployment compensation recipient; or

(2) is not eligible for health care benefits under an employer-sponsored health benefits plan.

(b) TYPES OF COVERAGE.—(1) A member eligible under subsection (a) may enroll for either of the following types of coverage:

(A) Self alone coverage.

(B) Self and family coverage.

(2) An enrollment by a member for self and family covers the

member and the dependents of the member who are described in

subparagraph (A), (D), or (I) of section 1072(2) of this title.

(c) OPEN ENROLLMENT PERIODS.—The Secretary of Defense

shall provide for at least one open enrollment period each year.

During an open enrollment period, a member eligible under subsection (a) may enroll in the TRICARE program or change or terminate an enrollment in the TRICARE program.

(d) SCOPE OF CARE.—(1) A member and the dependents of a

member enrolled in the TRICARE program under this section shall

be entitled to the same benefits under this chapter as a member

of the uniformed services on active duty or a dependent of such a

member, respectively.

(2) Section 1074(c) of this title shall apply with respect to a

member enrolled in the TRICARE program under this section.

(e) PREMIUMS.—(1) The Secretary of Defense shall charge premiums for coverage pursuant to enrollments under this section.

The Secretary shall prescribe for each of the TRICARE program options a premium for self alone coverage and a premium for self and

family coverage.

(2) The monthly amount of the premium in effect for a month

for a type of coverage under this section shall be the amount equal

to 28 percent of the total amount determined by the Secretary on

an appropriate actuarial basis as being reasonable for the coverage.

(3) The premiums payable by a member under this subsection

may be deducted and withheld from basic pay payable to the member under section 204 of title 37 or from compensation payable to

the member under section 206 of such title. The Secretary shall

prescribe the requirements and procedures applicable to the payment of premiums by members not entitled to such basic pay or

compensation.

(4) Amounts collected as premiums under this subsection shall

be credited to the appropriation available for the Defense Health

Program Account under section 1100 of this title, shall be merged

with sums in such Account that are available for the fiscal year in

which collected, and shall be available under subparagraph (B) of

such section for such fiscal year.
25 § 1076b CH. 55—MEDICAL AND DENTAL CARE

(f) OTHER CHARGES.—A person who receives health care pursuant to an enrollment in a TRICARE program option under this section, including a member who receives such health care, shall be

subject to the same deductibles, copayments, and other nonpremium charges for health care as apply under this chapter for

health care provided under the same TRICARE program option to

dependents described in subparagraph (A), (D), or (I) of section

1072(2) of this title.

(g) TERMINATION OF ENROLLMENT.—(1) A member enrolled in

the TRICARE program under this section may terminate the enrollment only during an open enrollment period provided under

subsection (c), except as provided in subsection (h).

(2) An enrollment of a member for self alone or for self and

family under this section shall terminate on the first day of the

first month beginning after the date on which the member ceases

to be eligible under subsection (a).

(3) The enrollment of a member under this section may be terminated on the basis of failure to pay the premium charged the

member under this section.

(h) RELATIONSHIP TO TRANSITION TRICARE COVERAGE UPON

SEPARATION FROM ACTIVE DUTY.—(1) A member may not enroll in

the TRICARE program under this section while entitled to transitional health care under subsection (a) of section 1145 of this title

or while authorized to receive health care under subsection (c) of

such section.

(2) A member who enrolls in the TRICARE program under this

section within 90 days after the date of the termination of the

member’s entitlement or eligibility to receive health care under

subsection (a) or (c) of section 1145 of this title may terminate the

enrollment at any time within one year after the date of the enrollment.

(i) CERTIFICATION OF NONCOVERAGE BY OTHER HEALTH BENEFITS PLAN.—The Secretary of Defense may require a member to

submit any certification that the Secretary considers appropriate to

substantiate the member’s assertion that the member is not covered for health care benefits under any other health benefits plan.

(j) ELIGIBLE UNEMPLOYMENT COMPENSATION RECIPIENT DEFINED.—In this section, the term ‘‘eligible unemployment compensation recipient’’ means, with respect to any month, any individual who is determined eligible for any day of such month for unemployment compensation under State law (as defined in section

205(9) of the Federal-State Extended Unemployment Compensation

Act of 1970), including Federal unemployment compensation laws

administered through the State.

(k) REGULATIONS.—The Secretary of Defense, in consultation

with the other administering Secretaries, shall prescribe regulations for the administration of this section.

(l) TERMINATION OF AUTHORITY.—An enrollment in TRICARE

under this section may not continue after December 31, 2004.

(Added P.L. 108–106, § 1115(a), Nov. 6, 2003, 117 Stat. 1216; revised in its entirety P.L. 108–

136, § 702, Nov. 24, 2003, 117 Stat. 1525.)
§ 1076c CH. 55—MEDICAL AND DENTAL CARE 26

§ 1076c. Dental insurance plan: certain retirees and their

surviving spouses and other dependents

(a) REQUIREMENT FOR PLAN.—The Secretary of Defense, in consultation with the other administering Secretaries, shall establish

a dental insurance plan for retirees of the uniformed services, certain unremarried surviving spouses, and dependents in accordance

with this section.

(b) PERSONS ELIGIBLE FOR PLAN.—The following persons are

eligible to enroll in the dental insurance plan established under

subsection (a):

(1) Members of the uniformed services who are entitled to

retired pay.

(2) Members of the Retired Reserve who would be entitled

to retired pay under chapter 1223 of this title but for being

under 60 years of age.

(3) Eligible dependents of a member described in paragraph (1) or (2) who are covered by the enrollment of the member in the plan.

(4) Eligible dependents of a member described in paragraph (1) or (2) who is not enrolled in the plan and who—

(A) is enrolled under section 1705 of title 38 to receive

dental care from the Secretary of Veterans Affairs;

(B) is enrolled in a dental plan that—

(i) is available to the member as a result of employment by the member that is separate from the

military service of the member; and

(ii) is not available to dependents of the member

as a result of such separate employment by the member; or

(C) is prevented by a medical or dental condition from

being able to obtain benefits under the plan.

(5) The unremarried surviving spouse and eligible child dependents of a deceased member—

(A) who died while in a status described in paragraph

(1) or (2);

(B) who is described in section 1448(d)(1) of this title;

or

(C) who died while on active duty for a period of more

than 30 days and whose eligible dependents are not eligible, or no longer eligible, for dental benefits under section

1076a of this title.

(c) PREMIUMS.—(1) A member enrolled in the dental insurance

plan established under subsection (a) shall pay the premiums

charged for the insurance coverage.

(2) The Secretary of Defense shall establish procedures for the

collection of the premiums charged for coverage by the dental insurance plan. To the maximum extent practicable, the premiums

payable by a member entitled to retired pay shall be deducted and

withheld from the retired pay of the member (if pay is available to

the member).

(d) BENEFITS AVAILABLE UNDER THE PLAN.—The dental insurance plan established under subsection (a) shall provide benefits

for dental care and treatment which may be comparable to the benefits authorized under section 1076a of this title for plans estab-
27 § 1076c CH. 55—MEDICAL AND DENTAL CARE

lished under that section and shall include diagnostic services, preventative services, endodontics and other basic restorative services,

surgical services, and emergency services.

(e) COVERAGE.—(1) The Secretary shall prescribe a minimum

required period for enrollment by a member or surviving spouse in

the dental insurance plan established under subsection (a).

(2) The dental insurance plan shall provide for voluntary enrollment of participants and shall authorize a member or eligible

unremarried surviving spouse to enroll for self only or for self and

eligible dependents.

(f) REQUIRED TERMINATIONS OF ENROLLMENT.—The Secretary

shall terminate the enrollment of any enrollee, and any eligible dependents of the enrollee covered by the enrollment, in the dental

insurance plan established under subsection (a) upon the occurrence of the following:

(1) In the case of an enrollment under subsection (b)(1),

termination of the member’s entitlement to retired pay.

(2) In the case of an enrollment under subsection (b)(2),

termination of the member’s status as a member of the Retired

Reserve.

(3) In the case of an enrollment under subsection (b)(5), remarriage of the surviving spouse.

(g) CONTINUATION OF DEPENDENTS’ ENROLLMENT UPON DEATH

OF ENROLLEE.—Coverage of a dependent in the dental insurance

plan established under subsection (a) under an enrollment of a

member or a surviving spouse who dies during the period of enrollment shall continue until the end of that period and may be renewed by (or for) the dependent, so long as the premium paid is

sufficient to cover continuation of the dependent’s enrollment. The

Secretary may terminate coverage of the dependent when the premiums paid are no longer sufficient to cover continuation of the enrollment. The Secretary shall prescribe in regulations under subsection (h) the parties responsible for paying the remaining premiums due on the enrollment and the manner for collection of the

premiums.

(h) REGULATIONS.—The dental insurance plan established

under subsection (a) shall be administered under regulations prescribed by the Secretary of Defense, in consultation with the other

administering Secretaries.

(i) VOLUNTARY DISENROLLMENT.—(1) With respect to enrollment in the dental insurance plan established under subsection (a),

the Secretary of Defense—

(A) shall allow for a period of up to 30 days at the beginning of the prescribed minimum enrollment period during

which an enrollee may disenroll; and

(B) shall provide for limited circumstances under which

disenrollment shall be permitted during the prescribed enrollment period, without jeopardizing the fiscal integrity of the

dental program.

(2) The circumstances described in paragraph (1)(B) shall

include—

(A) a case in which a retired member, surviving spouse, or

dependent of a retired member who is also a Federal employee

is assigned to a location outside the jurisdiction of the dental
§ 1077 CH. 55—MEDICAL AND DENTAL CARE 28

insurance plan established under subsection (a) that prevents

utilization of dental benefits under the plan;

(B) a case in which a retired member, surviving spouse, or

dependent of a retired member is prevented by a serious medical condition from being able to obtain benefits under the

plan;

(C) a case in which severe financial hardship would result;

and

(D) any other circumstances which the Secretary considers

appropriate.

(3) The Secretary shall establish procedures for timely decisions on requests for disenrollment under this section and for appeal to the TRICARE Management Activity of adverse decisions.

(j) DEFINITIONS.—In this section:

(1) The term ‘‘eligible dependent’’ means a dependent described in subparagraph (A), (D), or (I) of section 1072(2) of

this title.

(2) The term ‘‘eligible child dependent’’ means a dependent

described in subparagraph (D) or (I) of section 1072(2) of this

title.

(3) The term ‘‘retired pay’’ includes retainer pay.

(Added P.L. 104–201, § 703(a)(1), Sept. 23, 1996, 110 Stat. 2588; amended P.L. 105–85, § 701,

733(b), 734, Nov. 18, 1997, 111 Stat. 1807, 1812, 1813; P.L. 105–261, § 702, Oct. 17, 1998, 112

Stat. 2056; P.L. 106–65, § 704, Oct. 5, 1999, 113 Stat. 683; P.L. 106–398, § 1[§ 726, 1087(a)(6)],

Oct. 30, 2000, 114 Stat. 1654, 1654A–187, 1654A–290.)

§ 1077. Medical care for dependents: authorized care in facilities of uniformed services

(a) Only the following types of health care may be provided

under section 1076 of this title:

(1) Hospitalization.

(2) Outpatient care.

(3) Drugs.

(4) Treatment of medical and surgical conditions.

(5) Treatment of nervous, mental, and chronic conditions.

(6) Treatment of contagious diseases.

(7) Physical examinations, including eye examinations, and

immunizations.

(8) Maternity and infant care, including well-baby care

that includes one screening of an infant for the level of lead in

the blood of the infant.

(9) Diagnostic tests and services, including laboratory and

X-ray examinations.

(10) Dental care.

(11) Ambulance service and home calls when medically

necessary.

(12) Durable equipment, which may be provided on a loan

basis.

(13) Primary and preventive health care services for

women (as defined in section 1074d(b) of this title).

(14) Preventive health care screening for colon or prostate

cancer, at the intervals and using the screening methods prescribed under section 1074d(a)(2) of this title.

(15) Prosthetic devices, as determined by the Secretary of

Defense to be necessary because of significant conditions resulting from trauma, congenital anomalies, or disease.
29 § 1077 CH. 55—MEDICAL AND DENTAL CARE

(16) A hearing aid, but only for a dependent of a member

of the uniformed services on active duty and only if the dependent has a profound hearing loss, as determined under

standards prescribed in regulations by the Secretary of Defense in consultation with the administering Secretaries.

(17) Any rehabilitative therapy to improve, restore, or

maintain function, or to minimize or prevent deterioration of

function, of a patient when prescribed by a physician.

(b) The following types of health care may not be provided

under section 1076 of this title:

(1) Domiciliary or custodial care.

(2) Orthopedic footwear and spectacles, except that, outside of the United States and at stations inside the United

States where adequate civilian facilities are unavailable, such

items may be sold to dependents at cost to the United States.

(3) The elective correction of minor dermatological blemishes and marks or minor anatomical anomalies.

(c) A dependent participating under a dental plan established

under section 1076a of this title may not be provided dental care

under section 1076(a) of this title except for emergency dental care,

dental care provided outside the United States, and dental care

that is not covered by such plan.

(d)(1) Notwithstanding subsection (b)(1), hospice care may be

provided under section 1076 of this title in facilities of the uniformed services to a terminally ill patient who chooses (pursuant

to regulations prescribed by the Secretary of Defense in consultation with the other administering Secretaries) to receive hospice

care rather than continuing hospitalization or other health care

services for treatment of the patient’s terminal illness.

(2) In this section, the term ‘‘hospice care’’ means the items

and services described in section 1861(dd) of the Social Security Act

(42 U.S.C. 1395x(dd)).

(e)(1) Authority to provide a prosthetic device under subsection

(a)(15) includes authority to provide the following:

(A) Any accessory or item of supply that is used in conjunction with the device for the purpose of achieving therapeutic benefit and proper functioning.

(B) Services necessary to train the recipient of the device

in the use of the device.

(C) Repair of the device for normal wear and tear or damage.

(D) Replacement of the device if the device is lost or irreparably damaged or the cost of repair would exceed 60 percent

of the cost of replacement.

(2) An augmentative communication device may be provided as

a voice prosthesis under subsection (a)(15).

(3) A prosthetic device customized for a patient may be provided under this section only by a prosthetic practitioner who is

qualified to customize the device, as determined under regulations

prescribed by the Secretary of Defense in consultation with the administering Secretaries.

(f)(1) Items that may be provided to a patient under subsection

(a)(12) include the following:

(A) Any durable medical equipment that can improve, restore, or maintain the function of a malformed, diseased, or in-
§ 1078 CH. 55—MEDICAL AND DENTAL CARE 30

jured body part, or can otherwise minimize or prevent the deterioration of the patient’s function or condition.

(B) Any durable medical equipment that can maximize the

patient’s function consistent with the patient’s physiological or

medical needs.

(C) Wheelchairs.

(D) Iron lungs.

(E) Hospital beds.

(2) In addition to the authority to provide durable medical

equipment under subsection (a)(12), any customization of equipment owned by the patient that is durable medical equipment authorized to be provided to the patient under this section or section

1079(a)(5) of this title, and any accessory or item of supply for any

such equipment, may be provided to the patient if the

customization, accessory, or item of supply is essential for—

(A) achieving therapeutic benefit for the patient;

(B) making the equipment serviceable; or

(C) otherwise assuring the proper functioning of the equipment.

(Added P.L. 85–861, § 1(25)(B), Sept. 2, 1958, 72 Stat. 1447; amended P.L. 89–614, § 2(4), Sept.

30, 1966, 80 Stat. 863; P.L 98–525, § 633(a), §§ 1401(e)(3), 1405(22), Oct. 19, 1984, 98 Stat. 2544,

2617, 2623; P.L. 99–145, § 702(a), § 703, Nov. 8, 1985, 99 Stat. 655; P.L. 102–190, §§ 702(a), 703,

Dec. 5, 1991, 105 Stat. 1400, 1401; P.L. 103–160, § 701(b), Nov. 30, 1993, 107 Stat. 1686; P.L.

103–337, §§ 703(b), 705, Oct. 5, 1994, 108 Stat. 2798, 2799; P.L. 104–201, § 701(b)(1), Sept. 23,

1996, 110 Stat. 2587; P.L. 105–85, § 702(b), Nov. 18, 1997, 111 Stat. 1807; P.L. 107–107, §§ 702,

703(a), 704, Dec. 28, 2001, 115 Stat. 1161, 1162.)

§ 1078. Medical and dental care for dependents: charges

(a) The Secretary of Defense, after consulting the other administering Secretaries, shall prescribe fair charges for inpatient medical and dental care given to dependents under section 1076 of this

title. The charge or charges prescribed shall be applied equally to

all classes of dependents.

(b) As a restraint on excessive demands for medical and dental

care under section 1076 of this title, uniform minimal charges may

be imposed for outpatient care. Charges may not be more than

such amounts, if any, as the Secretary of Defense may prescribe

after consulting the other administering Secretaries, and after a

finding that such charges are necessary.

(c) Amounts received for subsistence and medical and dental

care given under section 1076 of this title shall be deposited to the

credit of the appropriation supporting the maintenance and operation of the facility furnishing the care.

(Added P.L. 85–861, § 1(25)(B), Sept. 2, 1958, 72 Stat. 1448; amended P.L. 89–614, § 2(5), Sept.

30, 1966, 80 Stat. 863; P.L. 96–513, § 511(36), Dec. 12, 1980, 94 Stat. 2923; P.L. 98–557, § 19(6),

Oct. 30, 1984, 98 Stat. 2869; P.L. 102–325, § 414, July 23, 1992, 106 Stat. 513).

§ 1078a. Continued health benefits coverage

(a) PROVISION OF CONTINUED HEALTH COVERAGE.—The Secretary of Defense shall implement and carry out a program of continued health benefits coverage in accordance with this section to

provide persons described in subsection (b) with temporary health

benefits comparable to the health benefits provided for former civilian employees of the Federal Government and other persons under

section 8905a of title 5.

(b) ELIGIBLE PERSONS.—The persons referred to in subsection

(a) are the following:
31 § 1078a CH. 55—MEDICAL AND DENTAL CARE

(1) A member of the uniformed services who—

(A) is discharged or released from active duty (or fulltime National Guard duty), whether voluntarily or involuntarily, under other than adverse conditions, as characterized by the Secretary concerned;

(B) immediately preceding that discharge or release, is

entitled to medical and dental care under section 1074(a)

of this title (except in the case of a member discharged or

released from full-time National Guard duty); and

(C) after that discharge or release and any period of

transitional health care provided under section 1145(a) of

this title, would not otherwise be eligible for any benefits

under this chapter.

(2) A person who—

(A) ceases to meet the requirements for being considered an unmarried dependent child of a member or former

member of the uniformed services under section 1072(2)(D)

of this title or ceases to meet the requirements for being

considered an unmarried dependent under section

1072(2)(I) of this title;

(B) on the day before ceasing to meet those requirements, was covered under a health benefits plan under

this chapter or transitional health care under section

1145(a) of this title as a dependent of the member or

former member; and

(C) would not otherwise be eligible for any benefits

under this chapter.

(3) A person who—

(A) is an unremarried former spouse of a member or

former member of the uniformed services; and

(B) on the day before the date of the final decree of divorce, dissolution, or annulment was covered under a

health benefits plan under this chapter or transitional

health care under section 1145(a) of this title as a dependent of the member or former member; and

(C) is not a dependent of the member or former member under subparagraph (F) or (G) of section 1072(2) of

this title or ends a one-year period of dependency under

subparagraph (H) of such section.

(c) NOTIFICATION OF ELIGIBILITY.—(1) The Secretary of Defense

shall prescribe regulations to provide for persons described in subsection (b) to be notified of eligibility to receive health benefits

under this section.

(2) In the case of a member who becomes (or will become) eligible for continued coverage under subsection (b)(1), the regulations

shall provide for the Secretary concerned to notify the member of

the member’s rights under this section as part of preseparation

counseling conducted under section 1142 of this title or any other

provision of other law.

(3) In the case of a dependent of a member or former member

who becomes eligible for continued coverage under subsection

(b)(2), the regulations shall provide that—

(A) the member or former member may submit to the Secretary concerned a written notice of the dependent’s change in

status (including the dependent’s name, address, and such
§ 1078a CH. 55—MEDICAL AND DENTAL CARE 32

other information as the Secretary of Defense may require);

and

(B) the Secretary concerned shall, within 14 days after receiving that notice, inform the dependent of the dependent’s

rights under this section.

(4) In the case of a former spouse of a member or former member who becomes eligible for continued coverage under subsection

(b)(3), the regulations shall provide appropriate notification provisions and a 60-day election period under subsection (d)(3).

(d) ELECTION OF COVERAGE.—In order to obtain continued coverage under this section, an appropriate written election (submitted in such manner as the Secretary of Defense may prescribe)

shall be made as follows:

(1) In the case of a member described in subsection (b)(1),

the written election shall be submitted to the Secretary concerned before the end of the 60-day period beginning on the

later of—

(A) the date of the discharge or release of the member

from active duty or full-time National Guard duty;

(B) the date on which the period of transitional health

care applicable to the member under section 1145(a) of

this title ends; or

(C) the date the member receives the notification required pursuant to subsection (c).

(2)(A) In the case of a dependent of a member or former

member who becomes eligible for continued coverage under

subsection (b)(2), the written election shall be submitted to the

Secretary concerned before the end of the 60-day period beginning on the later of—

(i) the date on which the dependent first ceases to

meet the requirements for being considered a dependent

under subparagraph (D) or (I) of section 1072(2) of this

title; or

(ii) the date the dependent receives the notification

pursuant to subsection (c).

(B) Notwithstanding subparagraph (A), if the Secretary

concerned determines that the dependent’s parent has failed to

provide the notice referred to in subsection (c)(3)(A) with respect to the dependent in a timely fashion, the 60-day period

under this paragraph shall be based only on the date under

subparagraph (A)(i).

(3) In the case of a former spouse of a member or a former

member who becomes eligible for continued coverage under

subsection (b)(3), the written election shall be submitted to the

Secretary concerned before the end of the 60-day period beginning on the later of—

(A) the date as of which the former spouse first ceases

to meet the requirements for being considered a dependent

under section 1072(2) of this title; or

(B) such other date as the Secretary of Defense may

prescribe.

(e) COVERAGE OF DEPENDENTS.—A person eligible under subsection (b)(1) to elect to receive coverage may elect coverage either

as an individual or, if appropriate, for self and dependents. A per-
33 § 1078a CH. 55—MEDICAL AND DENTAL CARE

son eligible under subsection (b)(2) or subsection (b)(3) may elect

only individual coverage.

(f) CHARGES.—(1) Under arrangements satisfactory to the Secretary of Defense, a person receiving continued coverage under this

section shall be required to pay into the Military Health Care Account or other appropriate account an amount equal to the sum

of—

(A) the employee and agency contributions which would be

required in the case of a similarly situated employee enrolled

in a comparable health benefits plan under section

8905a(d)(1)(A)(i) of title 5; and

(B) an amount, not to exceed 10 percent of the amount determined under subparagraph (A), determined under regulations prescribed by the Secretary of Defense to be necessary for

administrative expenses; and

(2) If a person elects to continue coverage under this section

before the end of the applicable period under subsection (d), but

after the person’s coverage under this chapter (and any transitional

extension of coverage under section 1145(a) of this title) expires,

coverage shall be restored retroactively, with appropriate contributions (determined in accordance with paragraph (1)) and claims (if

any), to the same extent and effect as though no break in coverage

had occurred.

(g) PERIOD OF CONTINUED COVERAGE.—(1) Continued coverage

under this section may not extend beyond—

(A) in the case of a member described in subsection (b)(1),

the date which is 18 months after the date the member ceases

to be entitled to care under section 1074(a) of this title and any

transitional care under section 1145 of this title, as the case

may be;

(B) in the case of a person described in subsection (b)(2),

the date which is 36 months after the date on which the person

first ceases to meet the requirements for being considered a dependent under subparagraph (D) or (I) of section 1072(2) of

this title; and

(C) in the case of a person described in subsection (b)(3),

except as provided in paragraph (4), the date which is 36

months after the later of—

(i) the date on which the final decree of divorce, dissolution, or annulment occurs; and

(ii) if applicable, the date the one-year extension of dependency under section 1072(2)(H) of this title expires.

(2) Notwithstanding paragraph (1)(B), if a dependent of a

member becomes eligible for continued coverage under subsection

(b)(2) during a period of continued coverage of the member for self

and dependents under this section, extended coverage of the dependent under this section may not extend beyond the date which

is 36 months after the date the member became ineligible for medical and dental care under section 1074(a) of this title and any

transitional health care under section 1145(a) of this title.

(3) Notwithstanding paragraph (1)(C), if a person becomes eligible for continued coverage under subsection (b)(3) as the former

spouse of a member during a period of continued coverage of the

member for self and dependents under this section, extended coverage of the former spouse under this section may not extend be-
§ 1079 CH. 55—MEDICAL AND DENTAL CARE 34

yond the date which is 36 months after the date the member became ineligible for medical and dental care under section 1074(a)

of this title and any transitional health care under section 1145(a)

of this title.

(4)(A) Notwithstanding paragraph (1), in the case of a former

spouse described in subparagraph (B), continued coverage under

this section shall continue for such period as the former spouse

may request.

(B) A former spouse referred to in subparagraph (A) is a

former spouse of a member or former member (other than a former

spouse whose marriage was dissolved after the separation of the

member from the service unless such separation was by retirement)—

(i) who has not remarried before age 55 after the marriage

to the employee, former employee, or annuitant was dissolved;

(ii) who was enrolled in an approved health benefits plan

under this chapter as a family member at any time during the

18-month period before the date of the divorce, dissolution, or

annulment; and

(iii)(I) who is receiving any portion of the retired or retainer pay of the member or former member or an annuity

based on the retired or retainer pay of the member; or

(II) for whom a court order (as defined in section

1408(a)(2) of this title) has been issued for payment of any portion of the retired or retainer pay or for whom a court order

(as defined in section 1447(13) of this title) or a written agreement (whether voluntary or pursuant to a court order) provides

for an election by the member or former member to provide an

annuity to the former spouse.

(Added P.L. 102–484, § 4408(a)(1), Oct. 23, 1992, 106 Stat. 2708; amended P.L. 103–35,

§ 201(g)(1), May 31, 1993, 107 Stat. 99; P.L. 103–337, § 702(c), Oct. 5, 1994, 108 Stat. 2798; P.L.

104–201, § 1074(a)(4), Sept. 23, 1996, 110 Stat. 2658; P.L. 105–85, § 1073(a)(17), Nov. 18, 1997,

111 Stat. 1901; P.L. 108–136, § 713(a), Nov. 24, 2003, 117 Stat. 1530.)

§ 1079. Contracts for medical care for spouses and children:

plans

(a) To assure that medical care is available for dependents, as

described in subparagraphs (A), (D), and (I) of section 1072(2) of

this title, of members of the uniformed services who are on active

duty for a period of more than 30 days, the Secretary of Defense,

after consulting with the other administering Secretaries, shall

contract, under the authority of this section, for medical care for

those persons under such insurance, medical service, or health

plans as he considers appropriate. The types of health care authorized under this section shall be the same as those provided under

section 1076 of this title, except as follows:

(1) With respect to dental care, only that care required as

a necessary adjunct to medical or surgical treatment may be

provided.

(2) Consistent with such regulations as the Secretary of

Defense may prescribe regarding the content of health promotion and disease prevention visits, the schedule of pap

smears and mammograms, the schedule and method of colon

and prostate cancer screenings, and the types and schedule of

immunizations—
35 § 1079 CH. 55—MEDICAL AND DENTAL CARE

(A) for dependents under six years of age, both health

promotion and disease prevention visits and immunizations may be provided; and

(B) for dependents six years of age or older, health

promotion and disease prevention visits may be provided

in connection with immunizations or with diagnostic or

preventive pap smears and mammograms or colon and

prostate cancer screenings.

(3) Not more than one eye examination may be provided

to a patient in any calendar year.

(4) Under joint regulations to be prescribed by the administering Secretaires, the services of Christian Science practitioners and nurses and services obtained in Christian Science

sanatoriums may be provided.

(5) Durable equipment provided under this section may be

provided on a rental basis.

(6) Inpatient mental health services may not (except as

provided in subsection (i)) be provided to a patient in excess

of—

(A) 30 days in any year, in the case of a patient 19

years of age or older;

(B) 45 days in any year, in the case of a patient under

19 years of age; or

(C) 150 days in any year, in the case of inpatient mental health services provided as residential treatment care.

(7) Services in connection with nonemergency inpatient

hospital care may not be provided if such services are available

at a facility of the uniformed services located within a 40-mile

radius of the residence of the patient, except that those services may be provided in any case in which another insurance

plan or program provides primary coverage for those services.

(8) Services of pastoral counselors, family and child counselors, or marital counselors (other than certified marriage and

family therapists) may not be provided unless the patient has

been referred to the counselor by a medical doctor for treatment of a specific problem with the results of that treatment

to be communicated back to the medical doctor who made the

referral and services of certified marriage and family therapists may be provided consistent with such rules as may be

prescribed by the Secretary of Defense, including credentialing

criteria and a requirement that the therapists accept payment

under this section as full payment for all services provided.

(9) Special education may not be provided, except when

provided as secondary to the active psychiatric treatment on an

institutional inpatient basis.

(10) Therapy or counseling for sexual dysfunctions or sexual inadequacies may not be provided.

(11) Treatment of obesity may not be provided if obesity is

the sole or major condition treated.

(12) Surgery which improves physical appearance but is

not expected to significantly restore functions (including mammary augmentation, face lifts, and sex gender changes) may

not be provided, except that—

(A) breast reconstructive surgery following a mastectomy may be provided;
§ 1079 CH. 55—MEDICAL AND DENTAL CARE 36

(B) reconstructive surgery to correct serious deformities caused by congenital anomalies or accidental injuries

may be provided; and

(C) neoplastic surgery may be provided.

(13) Any service or supply which is not medically or psychologically necessary to prevent, diagnose, or treat a mental

or physical illness, injury, or bodily malfunction as assessed or

diagnosed by a physician, dentist, clinical psychologist, certified marriage and family therapist, optometrist, podiatrist,

certified nurse-midwife, certified nurse practitioner, or certified

clinical social worker, as appropriate, may not be provided, except as authorized in paragraph (4). Pursuant to an agreement

with the Secretary of Health and Human Services and under

such regulations as the Secretary of Defense may prescribe,

the Secretary of Defense may waive the operation of this paragraph in connection with clinical trials sponsored or approved

by the National Institutes of Health if the Secretary of Defense

determines that such a waiver will promote access by covered

beneficiaries to promising new treatments and contribute to

the development of such treatments.

(14) The prohibition contained in section 1077(b)(3) of this

title shall not apply in the case of a member or former member

of the uniformed services.

(15) Electronic cardio-respiratory home monitoring equipment (apnea monitors) for home use may be provided if a physician prescribes and supervises the use of the monitor for an

infant)—

(A) who has had an apparent life-threatening event,

(B) who is a subsequent sibling of a victim of sudden

infant death syndrome,

(C) whose birth weight was 1,500 grams or less, or

(D) who is a pre-term infant with pathologic apnea,

in which case the coverage may include the cost of the equipment, hard copy analysis of physiological alarms, professional

visits, diagnostic testing, family training on how to respond to

apparent life threatening events, and assistance necessary for

proper use of the equipment.

(16) Hospice care may be provided only in the manner and

under the conditions provided in section 1861(dd) of the Social

Security Act (42 U.S.C. 1395x(dd)).

(b) Plans covered by subsection (a) shall include provisions for

payment by the patient of the following amounts: (1) $25 for each admission to a hospital, or the amount the

patient would have been charged under section 1078(a) of this

title had the care being paid for been obtained in a hospital of

the uniformed services, whichever amount is the greater. The

Secretary of Defense may exempt a patient from paying such

amount if the hospital to which the patient is admitted does

not impose a legal obligation on any of its patients to pay for

inpatient care. (2) Except as provided in clause (3), the first $150 each fiscal year of the charges for all types of care authorized by subsection (a) and received while in an outpatient status and 20

percent of all subsequent charges for such care during a fiscal

year. Notwithstanding the preceding sentence, in the case of a
37 § 1079 CH. 55—MEDICAL AND DENTAL CARE

dependent of an enlisted member in a pay grade below E–5,

the initial deductible each fiscal year under this paragraph

shall be limited to $50.

(3) A family group of two or more persons covered by this

section shall not be required to pay collectively more than the

first $300 (or in the case of the family group of an enlisted

member in a pay grade below E–5, the first $100) each fiscal

year of the charges for all types of care authorized by subsection (a) and received while in an outpatient status and 20

percent of the additional charges for such care during a fiscal

year.

(4) $25 for surgical care that is authorized by subsection

(a) and received while in an outpatient status and that has

been designated (under joint regulations to be prescribed by

the administering Secretaries) as care to be treated as inpatient care for purposes of this subsection. Any care for which

payment is made under this clause shall not be considered to

be care received while in an outpatient status for purposes of

clauses (2) and (3).

(5) An individual or family group of two or more persons

covered by this section may not be required by reason of this

subsection to pay a total of more than $1,000 for health care

received during any fiscal year under a plan under subsection

(a).

(c) The methods for making payment under subsection (b) shall

be prescribed under joint regulations issued by the administering

Secretaries.

(d)(1) The Secretary of Defense shall establish a program to

provide extended benefits for eligible dependents, which may include the provision of comprehensive health care services, including

case management services, to assist in the reduction of the disabling effects of a qualifying condition of an eligible dependent.

Registration shall be required to receive the extended benefits.

(2) The Secretary of Defense, after consultation with the other

administering Secretaries, shall promulgate regulations to carry

out this subsection.

(3) In this subsection:

(A) The term ‘‘eligible dependent’’ means a dependent of a

member of the uniformed services on active duty for a period

of more than 30 days, as described in subparagraph (A), (D),

or (I) of section 1072(2) of this title, who has a qualifying condition.

(B) The term ‘‘qualifying condition’’ means the condition of

a dependent who is moderately or severely mentally retarded,

has a serious physical disability, or has an extraordinary physical or psychological condition.

(e) Extended benefits for eligible dependents under subsection

(d) may include comprehensive health care services (including services necessary to maintain, or minimize or prevent deterioration of,

function of the patient) and case management services with respect

to the qualifying condition of such a dependent, and include, to the

extent such benefits are not provided under provisions of this chapter other than under this section, the following:

(1) Diagnosis.
§ 1079 CH. 55—MEDICAL AND DENTAL CARE 38

(2) Inpatient, outpatient, and comprehensive home health

care supplies and services which may include cost effective and

medically appropriate services other than part-time or intermittent services (within the meaning of such terms as used in

the second sentence of section 1861(m) of the Social Security

Act).

(3) Training, rehabilitation, special education, and assistive technology devices.

(4) Institutional care in private nonprofit, public, and State

institutions and facilities and, if appropriate, transportation to

and from such institutions and facilities.

(5) Custodial care, notwithstanding the prohibition in section 1077(b)(1) of this title.

(6) Respite care for the primary caregiver of the eligible

dependent.

(7) Such other services and supplies as determined appropriate by the Secretary, notwithstanding the limitations in

subsection (a)(13).

(f)(1) Members shall be required to share in the cost of any

benefits provided to their dependents under subsection (d) as follows:

(A) Members in the lowest enlisted pay grade shall be required to pay the first $25 incurred each month, and members

in the highest commissioned pay grade shall be required to pay

the first $250 incurred each month. The amounts to be paid by

members in all other pay grades shall be determined under

regulations to be prescribed by the Secretary of Defense in consultation with the administering Secretaries.

(B) A member who has more than one dependent incurring

expenses in a given month under a plan covered by subsection

(d) shall not be required to pay an amount greater than would

be required if the member had only one such dependent.

(2) In the case of extended benefits provided under paragraph

(3) or (4) of subsection (e) to a dependent of a member of the uniformed services—

(A) the Government’s share of the total cost of providing such benefits in any month shall not exceed $2,500, except for

costs that a member is exempt from paying under paragraph

(3); and

(B) the member shall pay (in addition to any amount payable under paragraph (1)) the amount, if any, by which the

amount of such total cost for the month exceeds the Government’s maximum share under subparagraph (A).

(3) A member of the uniformed services who incurs expenses

under paragraph (2) for a month for more than one dependent shall

not be required to pay for the month under subparagraph (B) of

that paragraph an amount greater than the amount the member

would otherwise be required to pay under that subparagraph for

the month if the member were incurring expenses under that subparagraph for only one dependent.

(4) To qualify for extended benefits under paragraph (3) or (4)

of subsection (e), a dependent of a member of the uniformed services shall be required to use public facilities to the extent such facilities are available and adequate, as determined under joint regulations of the administering Secretaries.
39 § 1079 CH. 55—MEDICAL AND DENTAL CARE

(5) The Secretary of Defense, in consultation with the other administering Secretaries, shall prescribe regulations to carry out

this subsection.

(g) When a member dies while he is eligible for receipt of hostile fire pay under section 310 of title 37 or from a disease or injury

incurred while eligible for such pay, his dependents who are receiving benefits under a plan covered by subsection (d) shall continue

to be eligible for such benefits until they pass their twenty-first

birthday. In addition, when a member dies while on active duty for

a period of more than 30 days, the member’s dependents who are

receiving benefits under a plan covered by subsection (a) shall continue to be eligible for such benefits during the three-year period

beginning on the date of the death of the member.

(h)(1) Except as provided in paragraphs (2) and (3), payment

for a charge for services by an individual health care professional

(or other noninstitutional health care provider) for which a claim

is submitted under a plan contracted for under subsection (a) shall

be equal to an amount determined to be appropriate, to the extent

practicable, in accordance with the same reimbursement rules as

apply to payments for similar services under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.). The Secretary of Defense

shall determine the appropriate payment amount under this paragraph in consultation with the other administering Secretaries.

(2) The Secretary of Defense, in consultation with the other administering Secretaries, shall prescribe regulations to provide for

such exceptions to the payment limitations under paragraph (1) as

the Secretary determines to be necessary to assure that covered

beneficiaries retain adequate access to health care services. Such

exceptions may include the payment of amounts higher than the

amount allowed under paragraph (1) when enrollees in managed

care programs obtain covered services from nonparticipating providers. To provide a suitable transition from the payment methodologies in effect before February 10, 1996, to the methodology required by paragraph (1), the amount allowable for any service may

not be reduced by more than 15 percent below the amount allowed

for the same service during the immediately preceding 12-month

period (or other period as established by the Secretary of Defense).

(3) In addition to the authority provided under paragraph (2),

the Secretary of Defense may authorize the commander of a facility

of the uniformed services, the lead agent (if other than the commander), and the health care contractor to modify the payment

limitations under paragraph (1) for certain health care providers

when necessary to ensure both the availability of certain services

for covered beneficiaries and lower costs than would otherwise be

incurred to provide the services. With the consent of the health

care provider, the Secretary is also authorized to reduce the authorized payment for certain health care services below the amount

otherwise required by the payment limitations under paragraph

(1).

(4)(A) The Secretary of Defense, in consultation with the other

administering Secretaries, shall prescribe regulations to establish

limitations (similar to the limitations established under title XVIII

of the Social Security Act (42 U.S.C. 1395 et seq.)) on beneficiary

liability for charges of an individual health care professional (or

other noninstitutional health care provider).
§ 1079 CH. 55—MEDICAL AND DENTAL CARE 40

(B) The regulations shall include a restriction that prohibits an

individual health care professional (or other noninstitutional health

care provider) from billing a beneficiary for services for more than

the amount that is equal to—

(i) the excess of the limiting charge (as defined in section

1848(g)(2) of the Social Security Act (42 U.S.C. 1395w–4(g)(2)))

that would be applicable if the services had been provided by

the professional (or other provider) as an individual health

care professional (or other noninstitutional health care provider) on a nonassignment-related basis under part B of title

XVIII of such Act over the amount that is payable by the

United States for those services under this subsection, plus

(ii) any unpaid amounts of deductibles or copayments that

are payable directly to the professional (or other provider) by

the beneficiary.

(5) To assure access to care for all covered beneficiaries, the

Secretary of Defense, in consultation with the other administering

Secretaries, shall designate specific rates for reimbursement for

services in certain localities if the Secretary determines that without payment of such rates access to health care services would be

severely impaired. Such a determination shall be based on consideration of the number of providers in a locality who provide the

services, the number of such providers who are CHAMPUS participating providers, the number of covered beneficiaries under

CHAMPUS in the locality, the availability of military providers in

the location or a nearby location, and any other factors determined

to be relevant by the Secretary.

(i)(1) The limitation in subsection (a)(6) does not apply in the

case of inpatient mental health services—

(A) provided under the program for the handicapped under

subsection (d);

(B) provided as partial hospital care; or

(C) provided pursuant to a waiver authorized by the Secretary of Defense because of medical or psychological circumstances of the patient that are confirmed by a health professional who is not a Federal employee after a review, pursuant to rules prescribed by the Secretary, which takes into account the appropriate level of care for the patient, the intensity

of services required by the patient, and the availability of that

care.

(2) Notwithstanding subsection (b) or section 1086(b) of this

title, the Secretary of Defense (after consulting with the other administering Secretaries) may prescribe separate payment requirements (including deductibles, copayments, and catastrophic limits)

for the provision of mental health services to persons covered by

this section or section 1086 of this title. The payment requirements

may vary for different categories of covered beneficiaries, by type

of mental health service provided, and based on the location of the

covered beneficiaries.

(3)(A) Except as provided in subparagraph (B), the Secretary of

Defense shall require preadmission authorization before inpatient

mental health services may be provided to persons covered by this

section or section 1086 of this title. In the case of the provision of

emergency inpatient mental health services, approval for the con-
41 § 1079 CH. 55—MEDICAL AND DENTAL CARE

tinuation of such services shall be required within 72 hours after

admission.

(B) Preadmission authorization for inpatient mental health

services is not required under subparagraph (A) in the following

cases:

(i) In the case of an emergency.

(ii) In a case in which any benefits are payable for such

services under part A of title XVIII of the Social Security Act

(42 U.S.C. 1395c et seq.), subject to subparagraph (C).

(C) In a case of inpatient mental health services to which subparagraph (B)(ii) applies, the Secretary shall require advance authorization for a continuation of the provision of such services after

benefits cease to be payable for such services under such part A.

(j)(1) A benefit may not be paid under a plan covered by this

section in the case of a person enrolled in, or covered by, any other

insurance, medical service, or health plan, including any plan offered by a third-party payer (as defined in section 1095(h)(1) of this

title), to the extent that the benefit is also a benefit under the

other plan, except in the case of a plan administered under title

XIX of the Social Security Act (42 U.S.C. 1396 et seq.).

(2) The amount to be paid to a provider of services for services

provided under a plan covered by this section shall be determined

under joint regulations to be prescribed by the administering Secretaries which provide that the amount of such payments shall be determined to the extent practicable in accordance with the same reimbursement rules as apply to payments to providers of services of

the same type under title XVIII of the Social Security Act (42

U.S.C. 1395 et seq.).

(3) A contract for a plan covered by this section shall include

a clause that prohibits each provider of services under the plan

from billing any person covered by the plan for any balance of

charges for services in excess of the amount paid for those services

under the joint regulations referred to in paragraph (2), except for

any unpaid amounts of deductibles or copayments that are payable

directly to the provider by the person.

(4) In this subsection, the term ‘‘provider of services’’ means a

hospital, skilled nursing facility, comprehensive outpatient rehabilitation facility, home health agency, hospice program (as defined in

section 1861(dd)(2) of the Social Security Act (42 U.S.C.

1395x(dd)(2)), or other institutional facility providing services for

which payment may be made under a plan covered by this section.

(k) A plan covered by this section may include provision of

liver transplants (including the cost of acquisition and transportation of the donated liver) in accordance with this subsection.

Such a liver transplant may be provided if—

(1) the transplant is for a dependent considered appropriate for that procedure by the Secretary of Defense in consultation with the administering Secretaries and such other

entities as the Secretary considers appropriate; and

(2) the transplant is to be carried out at a health-care facility that has been approved for that purpose by the Secretary

of Defense after consultation with the Secretary of Health and

Human Services and such other entities as the Secretary considers appropriate.
§ 1079 CH. 55—MEDICAL AND DENTAL CARE 42

(l)(1) Contracts entered into under subsection (a) shall also provide for medical care for dependents of former members of the uniformed services who are authorized to receive medical and dental

care under section 1076(e) of this title in facilities of the uniformed

services.

(2) Except as provided in paragraph (3), medical care in the

case of a dependent described in section 1076(e) shall be furnished

under the same conditions and subject to the same limitations as

medical care furnished under this section to spouses and children

of members of the uniformed services described in the first sentence of subsection (a).

(3) Medical care may be furnished to a dependent pursuant to

paragraph (1) only for an injury, illness, or other condition described in section 1076(e) of this title.

(m)(1) Subject to paragraph (2), the Secretary of Defense may,

upon request, make payments under this section for a charge for

services for which a claim is submitted under a plan contracted for

under subsection (a) to a hospital that does not impose a legal obligation on any of its patients to pay for such services.

(2) A payment under paragraph (1) may not exceed the average

amount paid for comparable services in the geographic area in

which the hospital is located or, if no comparable services are available in that area, in an area similar to the area in which the hospital is located.

(3) The Secretary of Defense shall periodically review the billing practices of each hospital the Secretary approves for payment

under this subsection to ensure that the hospital’s practices of not

billing patients for payment are not resulting in increased costs to

the Government.

(4) The Secretary of Defense may require each hospital the

Secretary approves for payment under this subsection to provide

evidence that it has sources of revenue to cover unbilled costs.

(n) The Secretary of Defense may enter into contracts (or

amend existing contracts) with fiscal intermediaries under which

the intermediaries agree to organize and operate, directly or

through subcontractors, managed health care networks for the provision of health care under this chapter. The managed health care

networks shall include cost containment methods, such as utilization review and contracting for care on a discounted basis.

(o)(1) Health care services provided pursuant to this section or

section 1086 of this title (or pursuant to any other contract or

project under the Civilian Health and Medical Program of the Uniformed Services) may not include services determined under the

CHAMPUS Peer Review Organization program to be not medically

or psychologically necessary.

(2) The Secretary of Defense, after consulting with the other

administering Secretaries, may adopt or adapt for use under the

CHAMPUS Peer Review Organization program, as the Secretary

considers appropriate, any of the quality and utilization review requirements and procedures that are used by the Peer Review Organization program under part B of title XI of the Social Security Act

(42 U.S.C. 1320c et seq.).

(p)(1) Subject to such exceptions as the Secretary of Defense

considers necessary, coverage for medical care under this section

for the dependents described in paragraph (3), and standards with
43 § 1079 CH. 55—MEDICAL AND DENTAL CARE

respect to timely access to such care, shall be comparable to coverage for medical care and standards for timely access to such care

under the managed care option of the TRICARE program known as

TRICARE Prime.

(2) The Secretary of Defense shall enter into arrangements

with contractors under the TRICARE program or with other appropriate contractors for the timely and efficient processing of claims

under this subsection.

(3) This subsection applies with respect to a dependent referred to in subsection (a) who—

(A) is a dependent of a member of the uniformed services

referred to in section 1074(c)(3) of this title and is residing

with the member;

(B) is a dependent of a member who, after having served

in a duty assignment described in section 1074(c)(3) of this

title, has relocated without the dependent pursuant to orders

for a permanent change of duty station from a remote location

described in subparagraph (B)(ii) of such section where the

member and the dependent resided together while the member

served in such assignment, if the orders do not authorize dependents to accompany the member to the new duty station at

the expense of the United States and the dependent continues

to reside at the same remote location, or

(C) is a dependent of a reserve component member ordered

to active duty for a period of more than 30 days and is residing

with the member, and the residence is located more than 50

miles, or approximately one hour of driving time, from the

nearest military medical treatment facility adequate to provide

the needed care.

(4) The Secretary of Defense shall consult with the other administering Secretaries in the administration of this subsection.

(q) Subject to subsection (a), a physician or other health care

practitioner who is eligible to receive reimbursement for services

provided under medicare (as defined in section 1086(d)(3)(C) of this

title) shall be considered approved to provide medical care authorized under this section and section 1086 of this title unless the administering Secretaries have information indicating medicare,

TRICARE, or other Federal health care program integrity violations by the physician or other health care practitioner.

(Added P.L. 85–861, § 1(25)(B), Sept. 2, 1958, 72 Stat. 1448; amended P.L. 89–614, § 2(6), Sept.

30, 1966, 80 Stat. 863; P.L. 92–58, § 1, July 29, 1971, 85 Stat. 157; P.L. 95–485, § 806(a)(1), Oct.

20, 1978, 92 Stat. 1622; P.L. 96–342, § 810(a), (b), Sept. 8, 1980, 94 Stat. 1097; P.L. 96–513,

§§ 501(13), 511(36), (38), Dec. 12, 1980, 94 Stat. 2908, 2923; P.L. 96–552, Dec. 19, 1980, 94 Stat.

3254; P.L. 97–22, § 11(a)(2), July 10, 1981, 95 Stat. 137; P.L. 97–86, § 906(a)(1), Dec. 1, 1981,

95 Stat. 1117; P.L. 98–94, § 931(a), § 1268(4), Sept. 24, 1983, 97 Stat. 648, 705; P.L. 98–525,

§ 632(a)(1), §§ 1401(e)(4), 1405(23), Oct. 19, 1984, 98 Stat. 2543, 2617, 2623; P.L. 98–557, § 19(7),

Oct. 30, 1984, 98 Stat. 2869; P.L. 99–661, §§ 652(d), 703, Nov. 14, 1986, 100 Stat. 3889, 3900;

P.L. 100–180, §§ 721(a), 726, Dec. 4, 1987, 101 Stat. 1115, 1117; P.L. 100–456, § 646(a), Sept.

29, 1988, 102 Stat. 1989; P.L. 101–189, § 730(a), Nov. 29, 1989, 103 Stat. 1481; P.L. 101–510,

§§ 701(a), 702(a), 703, 712(a), 1484(g)(1), Nov. 5, 1990, 104 Stat. 1580, 1581, 1583, 1717; P.L.

102–190, §§ 702(b), 711, 712(a), 713, Dec. 5, 1991, 105 Stat. 1400, 1402, 1402, 1403; P.L. 102–

484, §§ 704, 1052(13), Oct. 23, 1992, 106 Stat. 2432, 2499; P.L. 103–35, § 202(a)(5), May 31, 1993,

107 Stat. 101; P.L. 103–160, §§ 711, 716(c), Nov. 30, 1993, 107 Stat. 1688, 1693; P.L. 103–337,

§§ 702(a), 707(a), Oct. 5, 1994, 108 Stat. 2797, 2800; P.L. 104–106, §§ 701, 731(a)–(d), Feb. 10,

1996, 110 Stat. 370, 380; P.L. 104–201, §§ 701(b)(2), 711, 731, 732, 735(c), Sept. 23, 1996, 110

Stat. 2587, 2590, 2597, 2599; P.L. 105–85, § 735, Nov. 18, 1997, 111 Stat. 1813; P.L. 106–398,

§ 1[§ 701(c)(1), 704(b), 722(b)(1), 757(a)], Oct. 30, 2000, 114 Stat. 1654, 1654A–172, 1654A–175,

1654A–185, 1654A–198; P.L. 107–107, § 701(b), (g)(2), 703(b), 707(a), (b), 1048(c)(5), Dec. 28,

2001, 115 Stat. 1158, 1161, 1162, 1163, 1226; P.L. 107–314, §§ 701(a), 702, 705(a), Dec. 2, 2002,

116 Stat. 2583, 2584.)
§ 1079a CH. 55—MEDICAL AND DENTAL CARE 44

§ 1079a. CHAMPUS: treatment of refunds and other

amounts collected

All refunds and other amounts collected in the administration

of the Civilian Health and Medical Program of the Uniformed Services shall be credited to the appropriation available for that program for the fiscal year in which the refund or amount is collected.

(Added P.L. 104–201, § 733, Sept. 23, 1996, 110 Stat. 2597.)

§ 1079b. Procedures for charging fees for care provided to

civilians; retention and use of fees collected

(a) REQUIREMENT TO IMPLEMENT PROCEDURES.—The Secretary

of Defense shall implement procedures under which a military

medical treatment facility may charge civilians who are not covered

beneficiaries (or their insurers) fees representing the costs, as determined by the Secretary, of trauma and other medical care provided to such civilians.

(b) USE OF FEES COLLECTED.—A military medical treatment facility may retain and use the amounts collected under subsection

(a) for—

(1) trauma consortium activities;

(2) administrative, operating, and equipment costs; and

(3) readiness training.

(Added P.L. 107–107, § 732(a)(1), Dec. 28, 2001, 115 Stat. 1169.)

§ 1080. Contracts for medical care for spouses and children:

election of facilities

(a) ELECTION.—A dependent covered by section 1079 of this

title may elect to receive inpatient medical care either in (1) the

facilities of the uniformed services, under the conditions prescribed

by sections 1076–1078 of this title, or (2) the facilities provided

under a plan contracted for under section 1079 of this title. However, under such regulations as the Secretary of Defense, after consulting the other administering Secretaries, may prescribe, the

right to make this election may be limited for dependents residing

in the area where the member concerned is assigned, if adequate

medical facilities of the uniformed services are available in that

area for those dependents.

(b) ISSUANCE OF NONAVAILABILITY-OF-HEALTH-CARE-STATE- MENTS.—In determining whether to issue a nonavailability-ofhealth-care-statement for a dependent described in subsection (a),

the commanding officer of a facility of the uniformed services may

consider the availability of health care services for the dependent

pursuant to any contract or agreement entered into under this

chapter for the provision of health care services. Notwithstanding

any other provision of law, with respect to obstetrics and gynecological care for beneficiaries not enrolled in a managed care plan

offered pursuant to any contract or agreement under this chapter,

a nonavailability-of-health-care statement shall be required for receipt of health care services related to outpatient prenatal, outpatient or inpatient delivery, and outpatient post-partum care subsequent to the visit which confirms the pregnancy.

(c) WAIVERS AND EXCEPTIONS TO REQUIREMENTS.—(1) A covered beneficiary enrolled in a managed care plan offered pursuant

to any contract or agreement under this chapter for the provision
45 § 1083 CH. 55—MEDICAL AND DENTAL CARE

of health care services shall not be required to obtain a nonavailability-of-health-care statement as a condition for the receipt of

health care.

(2) The Secretary of Defense may waive the requirement to obtain nonavailability-of-health-care statements following an evaluation of the effectiveness of such statements in optimizing the use

of facilities of the uniformed services.

(Added P.L. 85–861, § 1(25)(B), Sept. 2, 1958, 72 Stat. 1449; amended P.L. 96–513, § 511(36),

Dec. 12, 1980, 94 Stat. 2923; P.L. 98–557, § 19(8), Oct. 30, 1984, 98 Stat. 2870; P.L. 103–160,

§ 716(b)(1), Nov. 30, 1993, 107 Stat. 1892; P.L. 104–201, § 734, Sept. 23, 1996, 110 Stat. 2598;

P.L. 106–65, § 712(c), Oct. 5, 1999, 113 Stat. 687.)

§ 1081. Contracts for medical care for spouses and children:

review and adjustment of payments

Each plan under section 1079 of this title shall provide for a

review, and if necessary an adjustment of payments, by the appropriate administering Secretary, not later than 120 days after the

close of each year the plan is in effect.

(Added P.L. 85–861, § 1(25)(B), Sept. 2, 1958, 72 Stat. 1449; amended P.L. 96–513, § 511(36),

Dec. 12, 1980, 94 Stat. 2923; P.L. 97–375, § 104(a), Dec. 21, 1982, 96 Stat. 1819; P.L. 98–94,

§ 1268(5)(A), Sept. 24, 1983, 97 Stat. 706; P.L. 98–557, § 19(9), Oct. 30, 1984, 98 Stat. 2870.)

§ 1082. Contracts for health care: advisory committees

To carry out sections 1079–1081 and 1086 of this title, the Secretary of Defense may establish advisory committees on insurance,

medical service, and health plans, to advise and make recommendations to him. He shall prescribe regulations defining their

scope, activities, and procedures. Each committee shall consist of

the Secretary, or his designee, as chairman, and such other persons

as the Secretary may select. So far as possible, the members shall

be representative of the organizations in the field of insurance,

medical service, and health plans. They shall serve without compensation but may be allowed transportation and a per diem payment in place of subsistence and other expenses.

(Added P.L. 85–861, § 1(25)(B), Sept. 2, 1958, 72 Stat. 1449; amended P.L. 89–614, § 2(8), Sept.

30, 1966, 80 Stat. 866.)

§ 1083. Contracts for medical care for spouses and children:

additional hospitalization

If a dependent covered by a plan under section 1079 of this

title needs hospitalization beyond the time limits in that plan, and

if the hospitalization is authorized in medical facilities of the uniformed services, he may be transferred to such a facility for additional hospitalization. If transfer is not feasible, the expenses of additional hospitalization in the civilian facility may be paid under

such regulations as the Secretary of Defense may prescribe after

consulting the other administering Secretaries.

(Added P.L. 85–861, § 1(25)(B), Sept. 2, 1958, 72 Stat. 1449; amended P.L. 96–513, § 511(36),

Dec. 12, 1980, 94 Stat. 2923; P.L. 98–557, § 19(10), Oct. 30, 1984, 98 Stat. 2870.)
§ 1084 CH. 55—MEDICAL AND DENTAL CARE 46

§ 1084. Determinations of dependency

A determination of dependency by an administering Secretary

under this chapter is conclusive. However, the administering Secretary may change a determination because of new evidence or for

other good cause. The Secretary’s determination may not be reviewed in any court or by the General Accounting Office, unless

there has been fraud or gross negligence.

(Added P.L. 85–861, § 1(25)(B), Sept. 2, 1958, 72 Stat. 1450; amended P.L. 89–614, § 2(1), Sept.

30, 1966, 80 Stat. 862; P.L. 96–513, § 511(34)(A), (36), Dec. 12, 1980, 94 Stat. 2922, 2923; P.L.

98–557 § 19(11), Oct. 30, 1984, 98 Stat. 2870.)

§ 1085. Medical and dental care from another executive department: reimbursement

If a member or former member of a uniformed service under

the jurisdiction of one executive department (or a dependent of

such a member or former member) receives inpatient medical or

dental care in a facility under the jurisdiction of another executive

department, the appropriation for maintaining and operating the

facility furnishing the care shall be reimbursed at rates established

by the President to reflect the average cost of providing the care.

(Added P.L. 85–861, § 1(25)(B), Sept. 2, 1958, 72 Stat. 1450; amended P.L. 89–264, § 1, Oct. 19,

1965, 79 Stat. 989; P.L. 96–513, § 511(36), (37), Dec. 12, 1980, 94 Stat. 2923; P.L. 98–94,

§ 1268(6), Sept. 24, 1983, 97 Stat. 706; P.L. 98–557, § 19(12), Oct. 30, 1984, 98 Stat. 2870; P.L.

99–145, § 1303(a)(8), Nov. 8, 1985, 99 Stat. 739.)

§ 1086. Contracts for health benefits for certain members,

former members, and their dependents

(a) To assure that health benefits are available for the persons

covered by subsection (c), the Secretary of Defense, after consulting

with the other administering Secretaries, shall contract under the

authority of this section for health benefits for those persons under

the same insurance, medical service, or health plans he contracts

for under section 1079(a) of this title. However, eye examinations

may not be provided under such plans for persons covered by subsection (c).

(b) For persons covered by this section the plans contracted for

under section 1079(a) of this title shall contain the following provisions for payment by the patient:

(1) Except as provided in clause (2), the first $150 each fiscal year of the charges for all types of care authorized by this

section and received while in an outpatient status and 25 percent of all subsequent charges for such care during a fiscal

year.

(2) A family group of two or more persons covered by this

section shall not be required to pay collectively more than the

first $300 each fiscal year of the charges for all types of care

authorized by this section and received while in an outpatient

status and 25 percent of the additional charges for such care

during a fiscal year.

(3) 25 percent of the charges for inpatient care. The Secretary of Defense may exempt a patient from paying such

charges if the hospital to which the patient is admitted does

not impose a legal obligation on any of its patients to pay for

inpatient care.

(4) A member or former member of a uniformed service

covered by this section by reason of section 1074(b) of this title,
47 § 1086 CH. 55—MEDICAL AND DENTAL CARE

or an individual or family group of two or more persons covered by this section, may not be required to pay a total of more

than $3,000 for health care received during any fiscal year

under a plan contracted for under section 1079(a) of this title.

(c) Except as provided in subsection (d), the following persons

are eligible for health benefits under this section:

(1) Those covered by sections 1074(b) and 1076(b) of this

title, except those covered by section 1072(2)(E) of this title.

(2) A dependent (other than a dependent covered by section 1072(2)(E) of this title) of a member of a uniformed

service—

(A) who died while on active duty for a period of more

than 30 days; or

(B) who died from an injury, illness, or disease incurred or aggravated—

(i) while on active duty under a call or order to active duty of 30 days or less, on active duty for training, or on inactive duty training; or

(ii) while traveling to or from the place at which

the member is to perform, or has performed, such active duty, active duty for training, or inactive duty

training.

(3) A dependent covered by clause (F), (G), or (H) of section

1072(2) of this title who is not eligible under paragraph (1).

(d)(1) A person who is entitled to hospital insurance benefits

under part A of title XVIII of the Social Security Act (42 U.S.C.

1395c et seq.) is not eligible for health benefits under this section.

(2) The prohibition contained in paragraph (1) shall not apply

to a person referred to in subsection (c) who—

(A) is enrolled in the supplementary medical insurance

program under part B of such title (42 U.S.C. 1395j et seq.);

and

(B) in the case of a person under 65 years of age, is entitled to hospital insurance benefits under part A of title XVIII

of the Social Security Act pursuant to subparagraph (A) or (C)

of section 226(b)(2) of such Act (42 U.S.C. 426(b)(2)) or section

226A(a) of such Act (42 U.S.C. 426–1(a)).

(3)(A) Subject to subparagraph (B), if a person described in

paragraph (2) receives medical or dental care for which payment

may be made under medicare and a plan contracted for under subsection (a), the amount payable for that care under the plan shall

be the amount of the actual out-of-pocket costs incurred by the person for that care over the sum of—

(i) the amount paid for that care under medicare; and

(ii) the total of all amounts paid or payable by third party

payers other than medicare.

(B) The amount payable for care under a plan pursuant to subparagraph (A) may not exceed the total amount that would be paid

under the plan if payment for that care were made solely under the

plan.

(C) In this paragraph:

(i) The term ‘‘medicare’’ means title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).

(ii) The term ‘‘third party payer’’ has the meaning given

such term in section 1095(h)(1) of this title.
§ 1086 CH. 55—MEDICAL AND DENTAL CARE 48

(4) The administering Secretaries shall develop a mechanism

by which persons described in subparagraph (B) of paragraph (2)

who do not satisfy the condition specified in subparagraph (A) of

such paragraph are promptly notified of their ineligibility for

health benefits under this section. In developing the notification

mechanism, the administering Secretaries shall consult with the

Administrator of the Centers for Medicare & Medicaid Services.

(e) A person covered by this section may elect to receive inpatient medical care either in (1) Government facilities, under the

conditions prescribed in sections 1074 and 1076–1078 of this title,

or (2) the facilities provided under a plan contracted for under this

section. However, under joint regulations issued by the administering Secretaries, the right to make this election may be limited

for those persons residing in an area where adequate facilities of

the uniformed service are available. In addition, subsections (b)

and (c) of section 1080 of this title shall apply in making the determination whether to issue a nonavailability of health care statement for a person covered by this section.

(f) The provisions of section 1079(h) of this title shall apply to

payments for services by an individual health-care professional (or

other noninstitutional health-care provider) under a plan contracted for under subsection (a).

(g) Section 1079(j) of this title shall apply to a plan contracted

for under this section, except that no person eligible for health benefits under this section may be denied benefits under this section

with respect to care or treatment for any service-connected disability which is compensable under chapter 11 of title 38 solely on

the basis that such person is entitled to care or treatment for such

disability in facilities of the Department of Veterans Affairs.

(h)(1) Subject to paragraph (2), the Secretary of Defense may,

upon request, make payments under this section for a charge for

services for which a claim is submitted under a plan contracted for

under subsection (a) to a hospital that does not impose a legal obligation on any of its patients to pay for such services.

(2) A payment under paragraph (1) may not exceed the average

amount paid for comparable services in the geographic area in

which the hospital is located or, if no comparable services are available in that area, in an area similar to the area in which the hospital is located.

(3) The Secretary of Defense shall periodically review the billing practices of each hospital the Secretary approves for payment

under this subsection to ensure that the hospital’s practices of not

billing patients for payment are not resulting in increased costs to

the Government.

(4) The Secretary of Defense may require each hospital the

Secretary approves for payment under this subsection to provide

evidence that it has sources of revenue to cover unbilled costs.

(Added P.L. 89–614, § 2(7), Sept. 30, 1966, 80 Stat. 865; amended P.L. 95–485, § 806(a)(2), Oct.

20, 1978, 92 Stat. 1622; P.L. 96–173, § 1, Dec. 29, 1979, 93 Stat. 1287; P.L. 96–513, §§ 501(14),

511(36), (39), Dec. 12, 1980, 94 Stat. 2908, 2923; P.L. 97–86, § 906(a)(2), Dec. 1, 1981, 95 Stat.

1117; P.L. 97–252, § 1004(c), Sept. 8, 1982, 96 Stat. 737; P.L. 98–94, § 931(b), Sept. 24, 1983,

97 Stat. 649; P.L. 98–525, § 632(a)(2), Oct. 19, 1984, 98 Stat. 2543; P.L. 98–557, § 19(13), Oct.

30, 1984, 98 Stat. 2870; P.L. 99–145, § 652(b), Nov. 8, 1985, 99 Stat. 656; P.L. 99–661,

§ 604(f)(1)(C), Nov. 14, 1986, 100 Stat. 3877; P.L. 100–180, § 721(b), Dec. 4, 1987, 101 Stat. 1115;

P.L. 100–456, § 646(b), Sept. 29, 1988, 102 Stat. 1989; P.L. 101–189, §§ 731(c)(2), 1621(a)(3), Nov.

29, 1989, 103 Stat. 1482, 1603; P.L. 101–510, § 712(b), Nov. 5, 1990, 104 Stat. 1583; P.L. 102–

190, § 704(a), (b)(1), Dec. 5, 1991, 105 Stat. 1401; P.L. 102–484, §§ 703(a), 705(a), Oct. 23, 1992,

106 Stat. 2432; P.L. 103–35, § 203(b)(2), May 31, 1993, 107 Stat. 102; P.L. 103–160, § 716(b)(2),
49 § 1086a CH. 55—MEDICAL AND DENTAL CARE

3Section 4408(c) of the National Defense Authorization Act for Fiscal Year 1993 (P.L. 102–

484, 106 Stat. 2712) provides:

(c) TERMINATION OF APPLICABILITY OF OTHER CONVERSION HEALTH POLICIES.—(1) No person

may purchase a conversion health policy under section 1145(b) or 1086a of title 10, United

States Code, on or after October 1, 1994. A person covered by such a conversion health policy

on that date may cancel that policy and enroll in a health benefits plan under section 1078a

of such title.

(2) No person may be covered concurrently by a conversion health policy under section 1145(b)

or 1086a of such title and a health benefits plan under section 1078a of such title.

Nov. 30, 1993, 107 Stat. 1693; P.L. 103–337, § 711, Oct. 5, 1994, 108 Stat. 2801; P.L. 104–106,

§ 732, Feb. 10, 1996, 110 Stat. 381; P.L. 104–201, § 734(a)(2), (b)(2), Sept. 23, 1996, 110 Stat.

2598; P.L. 106–398, § 1[§ 712(a)(1), 759], Oct. 30, 2000, 114 Stat. 1654, 1654A–176, 1654A–200;

P.L. 108–173, § 900(e)(4)(A), Dec. 8, 2003, 117 Stat. 2373.)

§ 1086a. Certain former spouses: extension of period of eligibility for health benefits

(a) AVAILABILITY OF CONVERSION HEALTH POLICIES.—The Secretary of Defense shall inform each person who has been a dependent for a period of one year or more under section 1072(2)(H) of this

title of the availability of a conversion health policy for purchase

by the person. A conversion health policy offered under this subsection shall provide coverage for not less than a 24-month period. 3

(b) EFFECT OF PURCHASE.—(1) Subject to paragraph (2), if a

person who is a dependent for a one-year period under section

1072(2)(H) of this title purchases a conversion health policy within

that period (or within a reasonable time after that period as prescribed by the Secretary of Defense), the person shall continue to

be eligible for medical and dental care in the manner described in

section 1076 of this title and health benefits under section 1086 of

this title until the end of the 24-month period beginning on the

later of—

(A) the date the person is no longer a dependent under section 1072(2)(H) of this title; and

(B) the date of the purchase of the policy.

(2) The extended period of eligibility provided under paragraph

(1) shall apply only with regard to a condition of the person that—

(A) exists on the date on which coverage under the conversion health policy begins; and

(B) for which care is not provided under the policy solely

on the grounds that the condition is a preexisting condition.

(c) EFFECT OF UNAVAILABILITY OF POLICIES.—(1) If the Secretary of Defense is unable, within a reasonable time, to enter into

a contract with a private insurer to offer conversion health policies

under subsection (a) at a rate not to exceed the payment required

under section 8905a(d)(1)(A) of title 5 for comparable coverage, the

Secretary shall provide the coverage required under such a policy

through the Civilian Health and Medical Program of the Uniformed

Services. Subject to paragraph (2), a person receiving coverage

under this subsection shall be required to pay into the Military

Health Care Account or other appropriate account an amount equal

to the sum of—

(A) the individual and Government contributions which

would be required in the case of a person enrolled in a health

benefits plan contracted for under section 1079 of this title;

and
§ 1086b CH. 55—MEDICAL AND DENTAL CARE 50

(B) an amount necessary for administrative expenses, but

not to exceed two percent of the amount under subparagraph

(A).

(2) The amount paid by a person who purchases a conversion

health policy from the Secretary of Defense under paragraph (1)

may not exceed the payment required under section 8905a(d)(1)(A)

of title 5 for comparable coverage.

(3) In order to reduce premiums required under paragraph (1),

the Secretary of Defense may offer a program of coverage that,

with respect to mental health services, offers reduced coverage and

increased cost-sharing by the purchaser.

(d) CONVERSION HEALTH POLICY DEFINED.—In this section, the

term ‘‘conversion health policy’’ means a health insurance policy

with a private insurer, developed through negotiations between the

Secretary of Defense and the private insurer, that is available for

one-year period under section 1072(2)(H) of this title.

(Added P.L. 101–189, § 731(b)(1), Nov. 29, 1989, 103 Stat. 1482; amended P.L. 102–484,

§ 4407(b), Oct. 23, 1992, 106 Stat. 2707; P.L. 103–35, § 202(a)(16), May 31, 1994, 107 Stat. 102.)

§ 1086b. Prohibition against requiring retired members to

receive health care solely through the Department

of Defense

The Secretary of Defense may not take any action that would

require, or have the effect of requiring, a member or former member of the armed forces who is entitled to retired or retainer pay

to enroll to receive health care from the Federal Government only

through the Department of Defense.

(Added P.L. 107–107, § 731(a), Dec. 28, 2001, 115 Stat. 1169.)

§ 1087. Programing facilities for certain members, former

members, and their dependents in construction

projects of the uniformed services

(a) Space for inpatient and outpatient care may be programed

in facilities of the uniformed services for persons covered by sections 1074(b) and 1076(b) of this title. The maximum amount of

space that may be so programed for a facility is the greater of—

(1) the amount of space that would be so programed for

the facility in order to meet the requirements to be placed on

the facility for support of the teaching and training of healthcare professionals; and

(2) the amount of space that would be so programed for

the facility based upon the most cost-effective provision of inpatient and outpatient care to persons covered by sections

1074(b) and 1076(b) of this title.

(b)(1) In making determinations for the purposes of clauses (1)

and (2) of subsection (a), the Secretary concerned shall take into

consideration—

(A) the amount of space that would be so programed for

the facility based upon projected inpatient and outpatient

workloads at the facility for persons covered by sections

1074(b) and 1076(b) of this title; and

(B) the anticipated capability of the medical and dental

staff of the facility, determined in accordance with regulations

prescribed by the Secretary of Defense and based upon realistic

projections of the number of physicians and other health-care
51 § 1089 CH. 55—MEDICAL AND DENTAL CARE

providers that it can reasonably be expected will be assigned

to or will otherwise be available to the facility.

(2) In addition, a determination made for the purpose of clause

(2) of subsection (a) shall be made in accordance with an economic

analysis (including a life-cycle cost analysis) of the facility and consideration of all reasonable and available medical care treatment

alternatives (including treatment provided under a contract under

section 1086 of this title or under part A of title XVIII of the Social

Security Act (42 U.S.C. 1395c et seq.)).

(Added P.L. 89–614, § 2(7), Sept. 30, 1966, 80 Stat. 866; amended P.L. 97–337, § 1, Oct. 15, 1982,

96 Stat. 1631; P.L. 98–525, § 1405(24), Oct. 19, 1984, 98 Stat. 2623; P.L. 99–661, § 1343(a)(4),

Nov. 14, 1986, 100 Stat. 3992.)

§ 1088. Air evacuation patients: furnished subsistence

Notwithstanding any other provision of law, and under regulations to be prescribed by the Secretary concerned, a person entitled

to medical and dental care under this chapter may be furnished

subsistence without charge while being evacuated as a patient by

military aircraft of the United States.

(Added P.L. 91–481, § 2(1), Oct. 21, 1970, 84 Stat. 1081.)

§ 1089. Defense of certain suits arising out of medical malpractice

(a) The remedy against the United States provided by sections

1346(b) and 2672 of title 28 for damages for personal injury, including death, caused by the negligent or wrongful act or omission of

any physician, dentist, nurse, pharmacist, or paramedical or other

supporting personnel (including medical and dental technicians,

nursing assistants, and therapists) of the armed forces, the National Guard while engaged in training or duty under section 316,

502, 503, 504, or 505 of title 32, the Department of Defense, the

Armed Forces Retirement Home, or the Central Intelligence Agency in the performance of medical, dental, or related health care

functions (including clinical studies and investigations) while acting within the scope of his duties or employment therein or therefor shall hereafter be exclusive of any other civil action or proceeding by reason of the same subject matter against such physician, dentist, nurse, pharmacist, or paramedical or other supporting personnel (or the estate of such person) whose act or omission gave rise to such action or proceeding. This subsection shall

also apply if the physician, dentist, nurse, pharmacist, or paramedical or other supporting personnel (or the estate of such person)

involved is serving under a personal services contract entered into

under section 1091 of this title.

(b) The Attorney General shall defend any civil action or proceeding brought in any court against any person referred to in subsection (a) of this section (or the estate of such person) for any such

injury. Any such person against whom such civil action or proceeding is brought shall deliver within such time after date of service or knowledge of service as determined by the Attorney General,

all process served upon such person or an attested true copy thereof to such person’s immediate superior or to whomever was designated by the head of the agency concerned to receive such papers

and such person shall promptly furnish copies of the pleading and

process therein to the United States attorney for the district em-
§ 1089 CH. 55—MEDICAL AND DENTAL CARE 52

bracing the place wherein the action or proceeding is brought, to

the Attorney General and to the head of the agency concerned.

(c) Upon a certification by the Attorney General that any person described in subsection (a) was acting in the scope of such person’s duties or employment at the time of the incident out of which

the suit arose, any such civil action or proceeding commenced in a

State court shall be removed without bond at any time before trial

by the Attorney General to the District Court of the United States

of the district and division embracing the place wherein it is pending and the proceeding deemed a tort action brought against the

United States under the provisions of title 28 and all references

thereto. Should a United States district court determine on a hearing on a motion to remand held before a trial on the merits that

the case so removed is one in which a remedy by suit within the

meaning of subsection (a) of this section is not available against the

United States, the case shall be remanded to the State court.

(d) The Attorney General may compromise or settle any claim

asserted in such civil action or proceeding in the manner provided

in section 2677 of title 28, and with the same effect.

(e) For purposes of this section, the provisions of section

2680(h) of title 28 shall not apply to any cause of action arising out

of a negligent or wrongful act or omission in the performance of

medical, dental, or related health care functions (including clinical

studies and investigations).

(f)(1) The head of the agency concerned may, to the extent that

the head of the agency concerned considers appropriate, hold harmless or provide liability insurance for any person described in subsection (a) for damages for personal injury, including death, caused

by such person’s negligent or wrongful act or omission in the performance of medical, dental, or related health care functions (including clinical studies and investigations) while acting within the

scope of such person’s duties if such person is assigned to a foreign

country or detailed for service with other than a Federal department, agency, or instrumentality or if the circumstances are such

as are likely to preclude the remedies of third persons against the

United States described in section 1346(b) of title 28, for such damage or injury.

(2) With respect to the Secretary of Defense and the Armed

Forces Retirement Home Board, the authority provided by paragraph (1) also includes the authority to provide for reasonable attorney’s fees for persons described in subsection (a), as determined

necessary pursuant to regulations prescribed by the head of the

agency concerned.

(g) In this section, the term ‘‘head of the agency concerned’’

means—

(1) the Director of Central Intelligence, in the case of an

employee of the Central Intelligence Agency;

(2) the Secretary of Homeland Security, in the case of a

member or employee of the Coast Guard when it is not operating as a service in the Navy;

(3) the Armed Forces Retirement Home Board, in the case

of an employee of the Armed Forces Retirement Home; and
53 § 1091 CH. 55—MEDICAL AND DENTAL CARE

(4) the Secretary of Defense, in all other cases.

(Added P.L. 94–464, § 1(a), Oct. 8, 1976, 90 Stat. 1985; amended P.L. 97–124, § 2, Dec. 29, 1981,

95 Stat. 1666; P.L. 98–94, § 934(a), (b), (c), Sept. 24, 1983, 97 Stat. 651, 652; P.L. 100–180,

§ 1231(18)(A), Dec. 4, 1987, 101 Stat. 1161; P.L. 101–510, § 1533(a)(1)(A), (B), Nov. 5, 1990, 104

Stat. 1733; P.L. 105–85, § 736(b), Nov. 18, 1997, 111 Stat. 1814; P.L. 107–296, § 1704(b)(1), Nov.

25, 2002, 116 Stat. 2314.)

§ 1090. Identifying and treating drug and alcohol dependence

The Secretary of Defense, and the Secretary of Homeland Security with respect to the Coast Guard when it is not operating as

a service in the Navy, shall prescribe regulations, implement procedures using each practical and available method, and provide necessary facilities to identify, treat, and rehabilitate members of the

armed forces who are dependent on drugs or alcohol.

(Added P.L. 97–295, § 1(15)(A), Oct. 12, 1982, 96 Stat. 1290; amended P.L. 98–94, § 1268(7),

Sept. 24, 1983, 97 Stat. 706; P.L. 101–510, § 553, Nov. 5, 1990, 104 Stat. 1567; P.L. 107–296,

§ 1704(b)(1), Nov. 25, 2002, 116 Stat. 2314.)

§ 1091. Personal services contracts

(a) AUTHORITY.—(1) The Secretary of Defense, with respect to

medical treatment facilities of the Department of Defense, and the

Secretary of Homeland Security, with respect to medical treatment

facilities of the Coast Guard when the Coast Guard is not operating

as a service in the Navy, may enter into personal services contracts

to carry out health care responsibilities in such facilities, as determined to be necessary by the Secretary. The authority provided in

this subsection is in addition to any other contract authorities of

the Secretary, including authorities relating to the management of

such facilities and the administration of this chapter.

(2) The Secretary of Defense, and the Secretary of Homeland

Security with respect to the Coast Guard when it is not operating

as a service in the Navy, may also enter into personal services contracts to carry out other health care responsibilities of the Secretary (such as the provision of medical screening examinations at

Military Entrance Processing Stations) at locations outside medical

treatment facilities, as determined necessary pursuant to regulations prescribed by the Secretary.

(b) LIMITATION ON AMOUNT OF COMPENSATION.—In no case

may the total amount of compensation paid to an individual in any

year under a personal services contract entered into under subsection (a) exceed the amount of annual compensation (excluding

the allowances for expenses) specified in section 102 of title 3.

(c) PROCEDURES.—(1) The Secretary shall establish by regulation procedures for entering into personal services contracts with

individuals under subsection (a). At a minimum, such procedures

shall assure—

(A) the provision of adequate notice of contract opportunities to individuals residing in the area of the medical treatment facility involved; and

(B) consideration of interested individuals solely on the

basis of the qualifications established for the contract and the

proposed contract price.

(2) Upon the establishment of the procedures under paragraph

(1), the Secretary may exempt contracts covered by this section
§ 1092 CH. 55—MEDICAL AND DENTAL CARE 54

from the competitive contracting requirements specified in section

2304 of this title or any other similar requirements of law.

(d) EXCEPTIONS.—The procedures and exemptions provided

under subsection (c) shall not apply to personal services contracts

entered into under subsection (a) with entities other than individuals or to any contract that is not an authorized personal services

contract under subsection (a).

(Added P.L. 98–94, § 932(a)(1), Sept. 24, 1983, 97 Stat. 649; amended P.L. 101–510, § 714, Nov.

5, 1990, 104 Stat. 1534; P.L. 103–160, § 712(a)(1), Nov. 30, 1993, 107 Stat. 1688; revised in its

entirety P.L. 103–160, § 712(a)(1), Nov. 30, 1993, 107 Stat. 1688; P.L. 104–106, § 733(a), Feb.

10, 1996, 110 Stat. 381; P.L. 105–85, § 736(a), Nov. 18, 1997, 111 Stat. 1814; P.L. 105–261,

§ 733(a), Oct. 17, 1998, 112 Stat. 2072; P.L. 106–398, § 1[§ 705], Oct. 30, 2000, 114 Stat. 1654,

1654A–175; P.L. 107–314, § 707, Dec. 2, 2002, 116 Stat. 2585; P.L. 107–296, § 1704(b)(1), Nov.

25, 2002, 116 Stat. 2314; P.L. 108–136, § 721, Nov. 24, 2003, 117 Stat. 1531.)

§ 1092. Studies and demonstration projects relating to delivery of health and medical care

(a)(1) The Secretary of Defense, in consultation with the other

administering Secretaries, shall conduct studies and demonstration

projects on the health care delivery system of the uniformed services with a view to improving the quality, efficiency, convenience,

and cost effectiveness of providing health care services (including

dental care services) under this title to members and former members and their dependents. Such studies and demonstration

projects may include the following:

(A) Alternative methods of payment for health and medical

care services.

(B) Cost-sharing by eligible beneficiaries.

(C) Methods of encouraging efficient and economical delivery of health and medical care services.

(D) Innovative approaches to delivery and financing of

health and medical care services.

(E) Alternative approaches to reimbursement for the administrative charges of health care plans.

(F) Prepayment for medical care services provided to maintain the health of a defined population.

(2) The Secretary of Defense shall include in the studies conducted under paragraph (1) alternative programs for the provision

of dental care to the spouses and dependents of members of the

uniformed services who are on active duty, including a program

under which dental care would be provided the spouses and dependents of such members under insurance or dental plan contracts. A demonstration project may not be conducted under this

section that provides for the furnishing of dental care under an insurance or dental plan contract.

(b) Subject to the availability of appropriations for that purpose, the Secretary of Defense may enter into contracts with public

or private agencies, institutions, and organizations to conduct studies and demonstration projects under subsection (a).

(c) The Secretary of Defense may obtain the advice and recommendations of such advisory committees as the Secretary considers appropriate. Each such committee consulted by the Secretary under this subsection shall evaluate the proposed study or

demonstration project as to the soundness of the objectives of such

study or demonstration project, the likelihood of obtaining productive results based on such study or demonstration project, the resources which were required to conduct such study or demonstra-
55 § 1094 CH. 55—MEDICAL AND DENTAL CARE

tion project, and the relationship of such study or demonstration

project to other ongoing or completed studies and demonstration

projects.

(Added P.L. 98–94, § 933(a)(1), Sept. 24, 1983, 97 Stat. 650; amended P.L. 98–557, § 19(14), Oct.

30, 1984, 98 Stat. 2870; P.L. 105–261, § 1031(a), Oct. 17, 1998, 112 Stat. 2123.)

§ 1093. Performance of abortions: restrictions

(a) RESTRICTION ON USE OF FUNDS.—Funds available to the

Department of Defense may not be used to perform abortions except where the life of the mother would be endangered if the fetus

were carried to term.

(b) RESTRICTION ON USE OF FACILITIES.—No medical treatment

facility or other facility of the Department of Defense may be used

to perform an abortion except where the life of the mother would

be endangered if the fetus were carried to term or in a case in

which the pregnancy is the result of an act of rape or incest.

(Added P.L. 98–525, § 1401(e)(5), Oct. 19, 1984, 98 Stat. 2617; amended P.L. 104–106, § 738(a),

(b)(1), Feb. 10, 1996, 110 Stat. 383.)

§ 1094. Licensure requirement for health-care professionals

(a)(1) A person under the jurisdiction of the Secretary of a military department may not provide health care independently as a

health-care professional under this chapter unless the person has

a current license to provide such care. In the case of a physician,

the physician may not provide health care as a physician under

this chapter unless the current license is an unrestricted license

that is not subject to limitation on the scope of practice ordinarily

granted to other physicians for a similar specialty by the jurisdiction that granted the license.

(2) The Secretary of Defense may waive paragraph (1) with respect to any person in unusual circumstances. The Secretary shall

prescribe by regulation the circumstances under which such a

waiver may be granted.

(b) The commanding officer of each health care facility of the

Department of Defense shall ensure that each person who provides

health care independently as a health-care professional at the facility meets the requirement of subsection (a).

(c)(1) A person (other than a person subject to chapter 47 of

this title) who provides health care in violation of subsection (a) is

subject to a civil money penalty of not more than $5,000.

(2) The provisions of subsections (c) and (e) through (h) of section 1128A of the Social Security Act (42 U.S.C. 1320a–7a) shall

apply to the imposition of a civil money penalty under paragraph

(1) in the same manner as they apply to the imposition of a civil

money penalty under that section, except that for purposes of this

subsection—

(A) a reference to the Secretary in that section is deemed

a reference to the Secretary of Defense; and

(B) a reference to a claimant in subsection (e) of that section is deemed a reference to the person described in paragraph (1).

(d)(1) Notwithstanding any law regarding the licensure of

health care providers, a health-care professional described in paragraph (2) may practice the health profession or professions of the

health-care professional in any State, the District of Columbia, or
§ 1094a CH. 55—MEDICAL AND DENTAL CARE 56

4Section 8026 of the Department of Defense Appropriations Act, 2004 (P.L. 108–87, 117 Stat.

1077) provides:

Sec. 8026. During the current fiscal year [FY04], net receipts pursuant to collections from

third party payers pursuant to section 1095 of title 10, United States Code, shall be made available to the local facility of the uniformed services responsible for the collections and shall be

over and above the facility’s direct budget amount.

a Commonwealth, territory, or possession of the United States, regardless of whether the practice occurs in a health care facility of

the Department of Defense, a civilian facility affiliated with the Department of Defense, or any other location authorized by the Secretary of Defense.

(2) A health-care professional referred to in paragraph (1) is a

member of the armed forces who—

(A) has a current license to practice medicine, osteopathic

medicine, dentistry, or another health profession; and

(B) is performing authorized duties for the Department of

Defense.

(e) In this section:

(1) The term ‘‘license’’—

(A) means a grant of permission by an official agency

of a State, the District of Columbia, or a Commonwealth,

territory, or possession of the United States to provide

health care independently as a health-care professional;

and

(B) includes, in the case of such care furnished in a

foreign country by any person who is not a national of the

United States, a grant of permission by an official agency

of that foreign country for that person to provide health

care independently as a health-care professional.

(2) The term ‘‘health-care professional’’ means a physician,

dentist, clinical psychologist, or nurse and any other person

providing direct patient care as may be designated by the Secretary of Defense in regulations.

(Added P.L. 99–145, § 653(a)(1), Nov. 8, 1985, 99 Stat. 658; amended P.L. 99–661, § 1343(a)(1),

Nov. 14, 1986, 100 Stat. 3992; P.L. 100–189, § 1622(e)(2)–(3), Nov. 29, 1989, 103 Stat. 1605; P.L.

101–189, §§ 653(e)(1), 1622(e)(3), Nov. 29, 1989, 103 Stat. 1463, 1605; P.L. 105–85, § 737, Nov.

18, 1997, 111 Stat. 1814; P.L. 105–261, § 743(a), Oct. 17, 1998, 112 Stat. 2072.)

§ 1094a. Continuing medical education requirements: system

for monitoring physician compliance

The Secretary of Defense shall establish a mechanism for ensuring that each person under the jurisdiction of the Secretary of

a military department who provides health care under this chapter

as a physician satisfies the continuing medical education requirements applicable to the physician.

(Added P.L. 105–261, § 734(b), Oct. 17, 1998, 112 Stat. 2073.)

§ 1095. Health care services incurred on behalf of covered

beneficiaries: collection from third-party payers

(a)(1) 4 In the case of a person who is a covered beneficiary, the

United States shall have the right to collect from a third-party

payer reasonable charges for health care services incurred by the

United States on behalf of such person through a facility of the uniformed services to the extent that the person would be eligible to

receive reimbursement or indemnification from the third-party

payer if the person were to incur such charges on the person’s own
57 § 1095 CH. 55—MEDICAL AND DENTAL CARE

behalf. If the insurance, medical service, or health plan of that

payer includes a requirement for a deductible or copayment by the

beneficiary of the plan, then the amount that the United States

may collect from the third-party payer is a reasonable charge for

the care provided less the appropriate deductible or copayment

amount.

(2) A covered beneficiary may not be required to pay an additional amount to the United States for health care services by reason of this section.

(b) No provision of any insurance, medical service, or health

plan contract or agreement having the effect of excluding from coverage or limiting payment of charges for certain care shall operate

to prevent collection by the United States under subsection (a) if

that care is provided—

(1) through a facility of the uniformed services;

(2) directly or indirectly by a governmental entity;

(3) to an individual who has no obligation to pay for that

care or for whom no other person has a legal obligation to pay;

or

(4) by a provider with which the third party payer has no

participation agreement.

(c) Under regulations prescribed under subsection (f), records

of the facility of the uniformed services that provided health care

services to a beneficiary of an insurance, medical service, or health

plan of a third-party payer shall be made available for inspection

and review by representatives of the payer from which collection by

the United States is sought.

(d) Notwithstanding subsections (a) and (b), and except as provided in subsection (j), collection may not be made under this section in the case of a plan administered under title XVIII or XIX of

the Social Security Act (42 U.S.C. 1395 et seq.).

(e)(1) The United States may institute and prosecute legal proceedings against a third-party payer to enforce a right of the

United States under this section.

(2) The administering Secretary may compromise, settle, or

waive a claim of the United States under this section.

(f) The Secretary of Defense, in consultation with the other administering Secretaries, shall prescribe regulations for the administration of this section. Such regulations shall provide for computation of the reasonable cost of health care services. Computation of

such reasonable cost may be based on—

(1) per diem rates;

(2) all-inclusive per visit rates;

(3) diagnosis-related groups; or

(4) such other method as may be appropriate.

(g) Amounts collected under this section from a third-party

payer or under any other provision of law from any other payer for

health care services provided at or through a facility of the uniformed services shall be credited to the appropriation supporting

the maintenance and operation of the facility and shall not be

taken into consideration in establishing the operating budget of the

facility.

(h) In this section:

(1) The term ‘‘third-party payer’’ means an entity that provides an insurance, medical service, or health plan by contract
§ 1095 CH. 55—MEDICAL AND DENTAL CARE 58

or agreement, including an automobile liability insurance or no

fault insurance carrier, and any other plan or program that is

designed to provide compensation or coverage for expenses incurred by a beneficiary for health care services or products.

Such term also includes entities described in subsection (j)

under the terms and to the extent provided in such subsection

and a workers’ compensation program or plan.

(2) The term ‘‘insurance, medical service, or health plan’’

includes a preferred provider organization, an insurance plan

described as Medicare supplemental insurance, and a personal

injury protection plan or medical payments benefit plan for

personal injuries resulting from the operation of a motor vehicle.

(3) The term ‘‘health care services’’ includes products

provided or purchased through a facility of the uniformed services.

(i)(1) In the case of a third-party payer that is an automobile

liability insurance or no fault insurance carrier, the right of the

United States to collect under this section shall extend to health

care services provided to a person entitled to health care under section 1074(a) of this title.

(2) In cases in which a tort liability is created upon some third

person, collection from a third-party payer that is an automobile liability insurance carrier shall be governed by the provisions of

Public Law 87–693 (42 U.S.C. 2651 et seq.).

(j) The Secretary of Defense may enter into an agreement with

any health maintenance organization, competitive medical plan,

health care prepayment plan, or other similar plan (pursuant to

regulations issued by the Secretary) providing for collection under

this section from such organization or plan for services provided to

a covered beneficiary who is an enrollee in such organization or

plan.

(k)(1) To improve the administration of this section and sections 1079(j)(1) and 1086(d) of this title, the Secretary of Defense,

in consultation with the other administering Secretaries, may prescribe regulations providing for the collection of information regarding insurance, medical service, or health plans of third-party payers held by covered beneficiaries.

(2) The collection of information under regulations prescribed

under paragraph (1) shall be conducted in the same manner as is

provided in section 1862(b)(5) of the Social Security Act (42 U.S.C.

1395y(b)(5)). The Secretary may provide for obtaining from the

Commissioner of Social Security employment information comparable to the information provided to the Administrator of the

Centers for Medicare & Medicaid Services pursuant to such section.

Such regulations may require the mandatory disclosure of Social

Security account numbers for all covered beneficiaries.

(3) The Secretary may disclose relevant employment information collected under this subsection to fiscal intermediaries or other

designated contractors.

(4) The Secretary may provide for contacting employers of covered beneficiaries to obtain group health plan information comparable to the information authorized to be obtained under section

1862(b)(5)(C) of the Social Security Act (42 U.S.C. 1395y(b)(5)(C)).

Notwithstanding clause (iii) of such section, clause (ii) of such sec-
59 § 1095b CH. 55—MEDICAL AND DENTAL CARE

tion regarding the imposition of civil money penalties shall apply

to the collection of information under this paragraph.

(5) Information obtained under this subsection may not be disclosed for any purpose other than to carry out the purpose of this

section and sections 1079(j)(1) and 1086(d) of this title.

(Added P.L. 99–272, § 2001(a)(1), April 7, 1986, 100 Stat. 100; amended P.L. 101–189, §§ 727(a),

1622(e)(5) Nov. 29, 1989, 103 Stat. 1480, 1605; P.L. 101–510, § 713, Nov. 5, 1990, 104 Stat. 1583;

P.L. 102–25, § 701(j)(8), April 6, 1991, 105 Stat. 116; P.L. 102–190, § 714, Dec. 5, 1991, 105 Stat.

1403; P.L. 103–160, § 713, Nov. 30, 1993, 107 Stat. 1689–1690; P.L. 103–337, §§ 714(b),

1070(b)(6), Oct. 5, 1994, 108 Stat. 2802, 2857; P.L. 104–106, § 734, Feb. 10, 1996, 110 Stat. 381;

P.L. 104–201, § 735(a), (b), Sept. 23, 1996, 110 Stat. 2598; P.L. 106–65, § 716(c)(1), Oct. 5, 1999,

113 Stat. 691; P.L. 107–314, § 1041(a)(5), Dec. 2, 2002, 116 Stat. 2645; P.L. 108–173,

§ 900(e)(4)(B), Dec. 8, 2003, 117 Stat. 2373.)

§ 1095a. Medical care: members held as captives and their

dependents

(a) Under regulations prescribed by the President, the Secretary concerned shall pay (by advancement or reimbursement) any

person who is a former captive, and any dependent of that person

or of a person who is in a captive status, for health care and other

expenses related to such care, to the extent that such care—

(1) is incident to the captive status; and

(2) is not covered—

(A) by any other Government medical or health program; or

(B) by insurance.

(b) In the case of any person who is eligible for medical care

under section 1074 or 1076 of this title, such regulations shall require that, whenever practicable, such care be provided in a facility

of the uniformed services.

(c) In this section:

(1) The terms ‘‘captive status’’ and ‘‘former captive’’ have

the meanings given those terms in section 559 of title 37.

(2) The term ‘‘dependent’’ has the meaning given that term

in section 551 of that title.

(Added as § 1095 P.L. 99–399, § 806(c)(1), Aug. 27, 1986, 100 Stat. 886; redesignated § 1095a P.L.

100–26, § 7(e)(2), April 21, 1987, 101 Stat. 281; amended P.L. 100–526, § 106(b)(1), Oct. 24, 1988,

102 Stat. 2625.)

§ 1095b. TRICARE program: contractor payment of certain

claims

(a) PAYMENT OF CLAIMS.—(1) The Secretary of Defense may

authorize a contractor under the TRICARE program to pay a claim

described in paragraph (2) before seeking to recover from a thirdparty payer the costs incurred by the contractor to provide health

care services that are the basis of the claim to a beneficiary under

such program.

(2) A claim under this paragraph is a claim—

(A) that is submitted to the contractor by a provider under

the TRICARE program for payment for services for health care

provided to a covered beneficiary; and

(B) that is identified by the contractor as a claim for which

a third-party payer may be liable.

(b) RECOVERY FROM THIRD-PARTY PAYERS.—The United States

shall have the same right to collect charges related to claims described in subsection (a) as charges for claims under section 1095

of this title.
§ 1095c CH. 55—MEDICAL AND DENTAL CARE 60

(c) DEFINITION OF THIRD-PARTY PAYER.—In this section, the

term ‘‘third-party payer’’ has the meaning given that term in section 1095(h) of this title, except that such term excludes primary

medical insurers.

(Added P.L. 105–261, § 711(a), Oct. 17, 1998, 112 Stat. 2058; amended P.L. 106–65, § 716(c)(2),

Oct. 5, 1999, 113 Stat. 692.)

§ 1095c. TRICARE program: facilitation of processing of

claims

(a) REDUCTION OF PROCESSING TIME.—(1) With respect to

claims for payment for medical care provided under the TRICARE

program, the Secretary of Defense shall implement a system for

processing of claims under which—

(A) 95 percent of all clean claims must be processed not

later than 30 days after the date that such claims are submitted to the claims processor; and

(B) 100 percent of all clean claims must be processed not

later than 100 days after the date that such claims are submitted to the claims processor.

(2) The Secretary may, under the system required by paragraph (1) and consistent with the provisions in chapter 39 of title

31 (commonly referred to as the ‘‘Prompt Payment Act’’), require

that interest be paid on clean claims that are not processed within

30 days.

(3) For purposes of this subsection, the term ‘‘clean claim’’

means a claim that has no defect, impropriety (including a lack of

any required substantiating documentation), or particular circumstance requiring special treatment that prevents timely payment on the claim under this section.

(b) REQUIREMENT TO PROVIDE START-UP TIME FOR CERTAIN

CONTRACTORS.—(1) Except as provided in paragraph (3), the Secretary of Defense shall not require that a contractor described in

paragraph (2) begin to provide managed care support pursuant to

a contract to provide such support under the TRICARE program

until at least nine months after the date of the award of the contract, but in no case later than one year after the date of such

award.

(2) A contractor under this paragraph is a contractor who is

awarded a contract to provide managed care support under the

TRICARE program—

(A) who has not previously been awarded such a contract

by the Department of Defense; or

(B) who has previously been awarded such a contract by

the Department of Defense but for whom the subcontractors

have not previously been awarded the subcontracts for such a

contract.

(3) The Secretary may reduce the nine-month start-up period

required under paragraph (1) if—

(A) the Secretary—

(i) determines that a shorter period is sufficient to ensure effective implementation of all contract requirements;

and

(ii) submits notification to the Committees on Armed

Services of the House of Representatives and the Senate of
61 § 1095e CH. 55—MEDICAL AND DENTAL CARE

the Secretary’s intent to reduce the nine-month start-up

period; and

(B) 60 days have elapsed since the date of such notification.

(c) INCENTIVES FOR ELECTRONIC PROCESSING.—The Secretary

of Defense shall require that new contracts for managed care support under the TRICARE program provide that the contractor be

permitted to provide financial incentives to health care providers

who file claims for payment electronically.

(d) CORRESPONDENCE TO MEDICARE CLAIMS INFORMATION REQUIREMENTS.—The Secretary of Defense, in consultation with the

other administering Secretaries, shall limit the information required in support of claims for payment for health care items and

services provided under the TRICARE program to that information

that is identical to the information that would be required for

claims for reimbursement for those items and services under title

XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) except for

that information, if any, that is uniquely required by the TRICARE

program. The Secretary of Defense shall report to the Committee

on Armed Services of the Senate and the Committee on Armed

Services of the House of Representatives any information that is

excepted under this provision, and the justification for that exception.

(Added P.L. 106–65, § 713(a)(1), Oct. 5, 1999, 113 Stat. 688; amended P.L. 107–107, § 708(b),

Dec. 28, 2001, 115 Stat. 1164; P.L. 107–314, § 711(a), Dec. 2, 2002, 116 Stat. 2588.)

§ 1095d. TRICARE program: waiver of certain deductibles

(a) WAIVER AUTHORIZED.—The Secretary of Defense may waive

the deductible payable for medical care provided under the

TRICARE program to an eligible dependent of—

(1) a member of a reserve component on active duty pursuant to a call or order to active duty for a period of less than

one year; or

(2) a member of the National Guard on full-time National

Guard duty pursuant to a call or order to full-time National

Guard duty for a period of less than one year.

(b) ELIGIBLE DEPENDENT.—As used in this section, the term

‘‘eligible dependent’’ means a dependent described in subparagraph

(A), (D), or (I) of section 1072(2) of this title.

(Added P.L. 106–65, § 714(a), Oct. 5, 1999, 113 Stat. 689; amended P.L. 106–398,

§ 1[§ 1087(a)(7)], Oct. 30, 2000, 114 Stat. 1654, 1654A–290.)

§ 1095e. TRICARE program: beneficiary counseling and assistance coordinators

(a) ESTABLISHMENT OF POSITIONS.—The Secretary of Defense

shall require in regulations that—

(1) each lead agent under the TRICARE program—

(A) designate a person to serve full-time as a beneficiary counseling and assistance coordinator for beneficiaries under the TRICARE program;

(B) designate for each of the TRICARE program regions at least one person (other than a person designated

under subparagraph (A)) to serve full-time as a beneficiary

counseling and assistance coordinator solely for members
§ 1095f CH. 55—MEDICAL AND DENTAL CARE 62

of the reserve components and their dependents who are

beneficiaries under the TRICARE program; and

(C) provide for toll-free telephone communication between such beneficiaries and the beneficiary counseling

and assistance coordinator; and

(2) the commander of each military medical treatment facility under this chapter designate a person to serve, as a primary or collateral duty, as beneficiary counseling and assistance coordinator for beneficiaries under the TRICARE program

served at that facility.

(b) DUTIES.—The Secretary shall prescribe the duties of the position of beneficiary counseling and assistance coordinator in the

regulations required by subsection (a).

(Added P.L. 106–65, § 715(a)(1), Oct. 5, 1999, 113 Stat. 690; amended P.L. 108–136, § 707, Nov.

24, 2003, 117 Stat. 1529.)

§ 1095f. TRICARE program: referrals for specialty health

care

The Secretary of Defense shall ensure that no contract for

managed care support under the TRICARE program includes any

requirement that a managed care support contractor require a primary care or specialty care provider to obtain prior authorization

before referring a patient to a specialty care provider that is part

of the network of health care providers or institutions of the contractor.

(Added P.L. 106–398, § 1[§ 728(a)(1)], Oct. 30, 2000, 114 Stat. 1654, 1654A–189.)

§ 1096. Military-civilian health services partnership program

(a) RESOURCES SHARING AGREEMENTS.—The Secretary of Defense may enter into an agreement providing for the sharing of resources between facilities of the uniformed services and facilities of

a civilian health care provider or providers that the Secretary contracts with under section 1079, 1086, or 1097 of this title if the Secretary determines that such an agreement would result in the delivery of health care to which covered beneficiaries are entitled

under this chapter in a more effective, efficient, or economical manner.

(b) ELIGIBLE RESOURCES.—An agreement entered into under

subsection (a) may provide for the sharing of—

(1) personnel (including support personnel);

(2) equipment;

(3) supplies; and

(4) any other items or facilities necessary for the provision

of health care services.

(c) COMPUTATION OF CHARGES.—A covered beneficiary, with respect to care provided to such beneficiary in facilities of the uniformed services under a sharing agreement entered into under subsection (a), shall pay—

(1) in the case of a dependent, the charges prescribed by

section 1078 of this title; and

(2) in the case of a member or former member entitled to

retired or retainer pay, the charges prescribed by section 1075

of this title.

(d) REIMBURSEMENT FOR LICENSE FEES.—In any case in which

it is necessary for a member of the uniformed services to pay a pro-
63 § 1097 CH. 55—MEDICAL AND DENTAL CARE

fessional license fee imposed by a government in order to provide

health care services at a facility of a civilian health care provider

pursuant to an agreement entered into under subsection (a), the

Secretary of Defense may reimburse the member for up to $500 of

the amount of the license fee paid by the member.

(Added P.L. 99–661, § 701(a)(1), Nov. 14, 1986, 100 Stat. 3894; amended P.L. 103–337, § 712,

Oct. 5, 1994, 108 Stat. 2801.)

§ 1097. Contracts for medical care for retirees, dependents,

and survivors: alternative delivery of health care

(a) IN GENERAL.—The Secretary of Defense, after consulting

with the other administering Secretaries, may contract for the delivery of health care to which covered beneficiaries are entitled

under this chapter. The Secretary may enter into a contract under

this section with any of the following:

(1) Health maintenance organizations.

(2) Preferred provider organizations.

(3) Individual providers, individual medical facilities, or insurers.

(4) Consortiums of such providers, facilities, or insurers.

(b) SCOPE OF COVERAGE UNDER HEALTH CARE PLANS.—A contract entered into under this section may provide for the delivery

of—

(1) selected health care services;

(2) total health care services for selected covered beneficiaries; or

(3) total health care services for all covered beneficiaries

who reside in a geographical area designated by the Secretary.

(c) COORDINATION WITH FACILITIES OF THE UNIFORMED SERVICES.—The Secretary of Defense may provide for the coordination

of health care services provided pursuant to any contract or agreement under this section with those services provided in medical

treatment facilities of the uniformed services. Subject to the availability of space and facilities and the capabilities of the medical or

dental staff, the Secretary may not deny access to facilities of the

uniformed services to a covered beneficiary on the basis of whether

the beneficiary enrolled or declined enrollment in any program established under, or operating in connection with, any contract

under this section. Notwithstanding the preferences established by

sections 1074(b) and 1076 of this title, the Secretary shall, as an

incentive for enrollment, establish reasonable preferences for services in facilities of the uniformed services for covered beneficiaries

enrolled in any program established under, or operating in connection with, any contract under this section.

(d) COORDINATION WITH OTHER HEALTH CARE PROGRAMS.—In

the case of a covered beneficiary who is enrolled in a managed

health care program not operated under the authority of this chapter, the Secretary may contract under this section with such other

managed health care program for the purpose of coordinating the

beneficiary’s dual entitlements under such program and this chapter. A managed health care program with which arrangements may

be made under this subsection includes any health maintenance organization, competitive medical plan, health care prepayment plan,

or other managed care program recognized pursuant to regulations

issued by the Secretary.
§ 1097a CH. 55—MEDICAL AND DENTAL CARE 64

(e) CHARGES FOR HEALTH CARE.—The Secretary of Defense

may prescribe by regulation a premium, deductible, copayment, or

other charge for health care provided under this section. In the

case of contracts for health care services under this section or

health care plans offered under section 1099 of this title for which

the Secretary permits covered beneficiaries who are covered by section 1086 of this title and who participate in such contracts or

plans to pay an enrollment fee in lieu of meeting the applicable deductible amount specified in section 1086(b) of this title, the Secretary may establish the same (or a lower) enrollment fee for covered beneficiaries described in section 1086(d)(1) of this title who

also participate in such contracts or plans. Without imposing additional costs on covered beneficiaries who participate in contracts for

health care services under this section or health care plans offered

under section 1099 of this title, the Secretary shall permit such

covered beneficiaries to pay, on a quarterly basis, any enrollment

fee required for such participation.

(Added P.L. 99–661, § 701(a)(1), Nov. 14, 1986, 100 Stat. 3895; amended P.L. 103–337, §§ 713,

714(a), Oct. 5, 1994, 108 Stat. 2802; P.L. 104–106, § § 712, 713, Feb. 10, 1996, 110 Stat. 374.)

§ 1097a. TRICARE Prime: automatic enrollments; payment

options

(a) AUTOMATIC ENROLLMENT OF CERTAIN DEPENDENTS.—Each

dependent of a member of the uniformed services in grade E4 or

below who is entitled to medical and dental care under section

1076(a)(2)(A) of this title and resides in the catchment area of a facility of a uniformed service offering TRICARE Prime shall be automatically enrolled in TRICARE Prime at the facility. The Secretary

concerned shall provide written notice of the enrollment to the

member. The enrollment of a dependent of the member may be terminated by the member or the dependent at any time.

(b) AUTOMATIC RENEWAL OF ENROLLMENTS OF COVERED BENE- FICIARIES.—(1) An enrollment of a covered beneficiary in TRICARE

Prime shall be automatically renewed upon the expiration of the

enrollment unless the renewal is declined.

(2) Not later than 15 days before the expiration date for an enrollment of a covered beneficiary in TRICARE Prime, the Secretary

concerned shall—

(A) transmit a written notification of the pending expiration and renewal of enrollment to the covered beneficiary or,

in the case of a dependent of a member of the uniformed services, to the member; and

(B) afford the beneficiary or member, as the case may be,

an opportunity to decline the renewal of enrollment.

(c) PAYMENT OPTIONS FOR RETIREES.—A member or former

member of the uniformed services eligible for medical care and dental care under section 1074(b) of this title may elect to have any

fee payable by the member or former member for an enrollment in

TRICARE Prime withheld from the member’s retired pay, retainer

pay, or equivalent pay, as the case may be, or to be paid from a

financial institution through electronic transfers of funds. The fee

shall be paid in accordance with the election. A member may elect

under this section to pay the fee in full at the beginning of the enrollment period or to make payments on a monthly or quarterly

basis.
65 § 1097b CH. 55—MEDICAL AND DENTAL CARE

(d) REGULATIONS AND EXCEPTIONS.—The Secretary of Defense

shall prescribe regulations, including procedures, to carry out this

section. Regulations prescribed to carry out the automatic enrollment requirements under this section may include such exceptions

to the automatic enrollment procedures as the Secretary determines appropriate for the effective operation of TRICARE Prime.

(e) NO COPAYMENT FOR IMMEDIATE FAMILY.—No copayment

shall be charged a member for care provided under TRICARE

Prime to a dependent of a member of the uniformed services described in subparagraph (A), (D), or (I) of section 1072(2) of this

title.

(f) DEFINITIONS.—In this section:

(1) The term ‘‘TRICARE Prime’’ means the managed care

option of the TRICARE program.

(2) The term ‘‘catchment area’’, with respect to a facility of

a uniformed service, means the service area of the facility, as

designated under regulations prescribed by the administering

Secretaries.

(Added P.L. 105–261, § 712(a), Oct. 17, 1998, 112 Stat. 2058; amended P.L. 106–398,

§ 1[§ 752(a)], Oct. 30, 2000, 114 Stat. 1654, 1654A–195; P.L. 107–107, § 1048(a)(11), Dec. 28,

2001, 115 Stat. 1223.)

§ 1097b. TRICARE program: financial management

(a) REIMBURSEMENT OF PROVIDERS.—(1) Subject to paragraph

(2), the Secretary of Defense may reimburse health care providers

under the TRICARE program at rates higher than the reimbursement rates otherwise authorized for the providers under that program if the Secretary determines that application of the higher

rates is necessary in order to ensure the availability of an adequate

number of qualified health care providers under that program.

(2) The amount of reimbursement provided under paragraph

(1) with respect to a health care service may not exceed the lesser

of the following:

(A) The amount equal to the local fee for service charge for

the service in the service area in which the service is provided

as determined by the Secretary based on one or more of the following payment rates:

(i) Usual, customary, and reasonable.

(ii) The Health Care Finance Administration’s Resource Based Relative Value Scale.

(iii) Negotiated fee schedules.

(iv) Global fees.

(v) Sliding scale individual fee allowances.

(B) The amount equal to 115 percent of the CHAMPUS

maximum allowable charge for the service.

(b) THIRD-PARTY COLLECTIONS.—(1) A medical treatment facility of the uniformed services under the TRICARE program has the

same right as the United States under section 1095 of this title to

collect from a third-party payer the reasonable charges for health

care services described in paragraph (2) that are incurred by the

facility on behalf of a covered beneficiary under that program.

(2) The Secretary of Defense shall prescribe regulations for the

administration of this subsection. The regulations shall set forth

the method to be used for the computation of the reasonable
§ 1098 CH. 55—MEDICAL AND DENTAL CARE 66

charges for inpatient, outpatient, and other health care services.

The method of computation may be—

(A) a method that is based on—

(i) per diem rates;

(ii) all-inclusive rates for each visit;

(iii) diagnosis-related groups; or

(iv) rates prescribed under the regulations implementing sections 1079 and 1086 of this title; or

(B) any other method considered appropriate.

(c) CONSULTATION REQUIREMENT.—The Secretary of Defense

shall carry out the responsibilities under this section after consultation with the other administering Secretaries.

(Added P.L. 106–65, § 716(a)(1), Oct. 5, 1999, 113 Stat. 690.)

§ 1098. Incentives for participation in cost-effective health

care plans

(a) WAIVER OF LIMITATIONS AND COPAYMENTS.—Subject to subsection (b), the Secretary of Defense, with respect to any plan contracted for under the authority of section 1079 or 1086 of this title,

may waive, in whole or in part—

(1) any limitation set out in the second sentence of section

1079(a) of this title; or

(2) any requirement for payment by the patient under section 1079(b) or 1086(b) of this title.

(b) DETERMINATION AND REPORT.—(1) Subject to paragraph (3),

the Secretary may waive a limitation or requirement as authorized

by subsection (a) if the Secretary determines that during the period

of the waiver such a plan will—

(A) be less costly to the Government than a plan subject

to such limitations or payment requirements; or

(B) provide better services than those provided by a plan

subject to such limitations or payment requirements at no additional cost to the Government.

(2) The Secretary shall submit to the Committee on Armed

Services of the Senate and the Committee on Armed Services of the

House of Representatives a report with respect to a waiver under

paragraph (1), including a comparison of costs of and benefits available under—

(A) a plan with respect to which the limitations and payment requirements are waived; and

(B) a plan with respect to which there is no such waiver.

(3) A waiver under paragraph (1) may not take effect until the

end of the 180-day period beginning on the date on which the Secretary submits the report required by paragraph (2) with respect

to such waiver.

(Added P.L. 99–661, § 701(a)(1), Nov. 14, 1986, 100 Stat. 3895; amended P.L. 101–510,

§ 1484(h)(1), Nov. 5, 1990, 104 Stat. 1717; P.L. 104–106, § 1502(a)(1), Feb. 10, 1996, 110 Stat.

502; P.L. 106–65, § 1067(1), Oct. 5, 1999, 113 Stat. 774.)

§ 1099. Health care enrollment system

(a) ESTABLISHMENT OF SYSTEM.—The Secretary of Defense,

after consultation with the other administering Secretaries, shall

establish a system of health care enrollment for covered beneficiaries who reside in the United States.

(b) DESCRIPTION OF SYSTEM.—Such system shall—
67 § 1101 CH. 55—MEDICAL AND DENTAL CARE

(1) allow covered beneficiaries to elect a health care plan

from eligible health care plans designated by the Secretary of

Defense; or

(2) if necessary in order to ensure full use of facilities of

the uniformed services in a geographical area, assign covered

beneficiaries who reside in such area to such facilities.

(c) HEALTH CARE PLANS AVAILABLE UNDER SYSTEM.—A health

care plan designated by the Secretary of Defense under the system

described in subsection (a) shall provide all health care to which a

covered beneficiary is entitled under this chapter. Such a plan may

consist of any of the following:

(1) Use of facilities of the uniformed services.

(2) The Civilian Health and Medical Program of the Uniformed Services.

(3) Any other health care plan contracted for by the Secretary of Defense.

(4) Any combination of the plans described in paragraphs

(1), (2), and (3).

(d) REGULATIONS.—The Secretary of Defense, after consultation

with the other administering Secretaries, shall prescribe regulations to carry out this section.

(Added P.L. 99–661, § 701(a)(1), Nov. 14, 1986, 100 Stat. 3896.)

§ 1100. Defense Health Program Account

(a) ESTABLISHMENT OF ACCOUNT.—(1) There is hereby established in the Department of Defense an account to be known as the

‘‘Defense Health Program Account’’. All sums appropriated to carry

out the functions of the Secretary of Defense with respect to medical and health care programs of the Department of Defense shall

be appropriated to the account.

(2) Of the total amount appropriated for a fiscal year for programs and activities carried out under this chapter, the amount

equal to three percent of such total amount shall remain available

for obligation until the end of the following fiscal year.

(b) OBLIGATION OF AMOUNTS FROM ACCOUNT BY SECRETARY OF

DEFENSE.—The Secretary of Defense may obligate or expend funds

from the account for purposes of conducting programs and activities under this chapter, including contracts entered into under section 1079, 1086, 1092, or 1097 of this title, to the extent amounts

are available in the account.

(c) REGULATIONS.—The Secretary of Defense shall prescribe

regulations to carry out this section.

(Added P.L. 99–661, § 701(a), Nov. 14, 1986, 100 Stat. 3896; and amended P.L. 104–106,

§ 735(a)–(d)(1), Feb. 10, 1996, 110 Stat. 382.)

§ 1101. Resource allocation methods: capitation or diagnosis-related groups

(a) ESTABLISHMENT OF CAPITATION OR DRG METHOD.—The

Secretary of Defense, after consultation with the other administering Secretaries, shall establish by regulation the use of capitation or diagnosis-related groups as the primary criteria for allocation of resources to facilities of the uniformed services.

(b) EXCEPTION FOR MOBILIZATION MISSIONS.—Capitation or diagnosis-related groups shall not be used to allocate resources to the
§ 1102 CH. 55—MEDICAL AND DENTAL CARE 68

facilities of the uniformed services to the extent that such resources

are required by such facilities for mobilization missions.

(c) CONTENT OF REGULATIONS.—Such regulations may establish a system of diagnosis-related groups similar to the system established under section 1886(d)(4) of the Social Security Act (42

U.S.C. 1395ww(d)(4)). Such regulations may include the following:

(1) A classification of inpatient treatments by diagnosis-related groups and a similar classification of outpatient treatment.

(2) A methodology for classifying specific treatments within such groups.

(3) An appropriate weighting factor for each such diagnosis-related group which reflects the relative resources used

by a facility of a uniformed service with respect to treatments

classified within that group compared to treatments classified

within other groups.

(4) An appropriate method for calculating or estimating

the annual per capita costs of providing comprehensive health

care services to members of the uniformed services on active

duty and covered beneficiaries.

(Added P.L. 99–661, § 701(a), Nov. 14, 1986, 100 Stat. 3897; amended P.L. 100–456, § 1233(e),

Sept. 29, 1988, 102 Stat. 2057; P.L. 103–160, § 714(a), (b)(1), Nov. 30, 1993, 107 Stat. 1690.)

§ 1102. Confidentiality of medical quality assurance records:

qualified immunity for participants

(a) CONFIDENTIALITY OF RECORDS.—Medical quality assurance

records created by or for the Department of Defense as part of a

medical quality assurance program are confidential and privileged.

Such records may not be disclosed to any person or entity, except

as provided in subsection (c).

(b) PROHIBITION ON DISCLOSURE AND TESTIMONY.—(1) No part

of any medical quality assurance record described in subsection (a)

may be subject to discovery or admitted into evidence in any judicial or administrative proceeding, except as provided in subsection

(c).

(2) A person who reviews or creates medical quality assurance

records for the Department of Defense or who participates in any

proceeding that reviews or creates such records may not be permitted or required to testify in any judicial or administrative proceeding with respect to such records or with respect to any finding,

recommendation, evaluation, opinion, or action taken by such person or body in connection with such records except as provided in

this section.

(c) AUTHORIZED DISCLOSURE AND TESTIMONY.—(1) Subject to

paragraph (2), a medical quality assurance record described in subsection (a) may be disclosed, and a person referred to in subsection

(b) may give testimony in connection with such a record, only as

follows:

(A) To a Federal executive agency or private organization,

if such medical quality assurance record or testimony is needed

by such agency or organization to perform licensing or accreditation functions related to Department of Defense health care

facilities or to perform monitoring, required by law, of Department of Defense health care facilities.
69 § 1102 CH. 55—MEDICAL AND DENTAL CARE

(B) To an administrative or judicial proceeding commenced

by a present or former Department of Defense health care provider concerning the termination, suspension, or limitation of

clinical privileges of such health care provider.

(C) To a governmental board or agency or to a professional

health care society or organization, if such medical quality assurance record or testimony is needed by such board, agency,

society, or organization to perform licensing, credentialing, or

the monitoring of professional standards with respect to any

health care provider who is or was a member or an employee

of the Department of Defense.

(D) To a hospital, medical center, or other institution that

provides health care services, if such medical quality assurance

record or testimony is needed by such institution to assess the

professional qualifications of any health care provider who is

or was a member or employee of the Department of Defense

and who has applied for or been granted authority or employment to provide health care services in or on behalf of such institution.

(E) To an officer, employee, or contractor of the Department of Defense who has a need for such record or testimony

to perform official duties.

(F) To a criminal or civil law enforcement agency or instrumentality charged under applicable law with the protection of

the public health or safety, if a qualified representative of such

agency or instrumentality makes a written request that such

record or testimony be provided for a purpose authorized by

law.

(G) In an administrative or judicial proceeding commenced

by a criminal or civil law enforcement agency or instrumentality referred to in subparagraph (F), but only with respect to

the subject of such proceeding.

(2) With the exception of the subject of a quality assurance action, the identity of any person receiving health care services from

the Department of Defense or the identity of any other person associated with such department for purposes of a medical quality assurance program that is disclosed in a medical quality assurance

record described in subsection (a) shall be deleted from that record

or document before any disclosure of such record is made outside

the Department of Defense. Such requirement does not apply to the

release of information pursuant to section 552a of title 5.

(d) DISCLOSURE FOR CERTAIN PURPOSES.—(1) Nothing in this

section shall be construed as authorizing or requiring the withholding from any person or entity aggregate statistical information

regarding the results of Department of Defense medical quality assurance programs.

(2) Nothing in this section shall be construed as authority to

withhold any medical quality assurance record from a committee of

either House of Congress, any joint committee of Congress, or the

General Accounting Office if such record pertains to any matter

within their respective jurisdictions.

(e) PROHIBITION ON DISCLOSURE OF RECORD OR TESTIMONY.—

A person or entity having possession of or access to a record or testimony described by this section may not disclose the contents of
§ 1102 CH. 55—MEDICAL AND DENTAL CARE 70

such record or testimony in any manner or for any purpose except

as provided in this section.

(f) EXEMPTION FROM FREEDOM OF INFORMATION ACT.—Medical

quality assurance records described in subsection (a) may not be

made available to any person under section 552 of title 5.

(g) LIMITATION ON CIVIL LIABILITY.—A person who participates

in or provides information to a person or body that reviews or creates medical quality assurance records described in subsection (a)

shall not be civilly liable for such participation or for providing

such information if the participation or provision of information

was in good faith based on prevailing professional standards at the

time the medical quality assurance program activity took place.

(h) APPLICATION TO INFORMATION IN CERTAIN OTHER

RECORDS.—Nothing in this section shall be construed as limiting

access to the information in a record created and maintained outside a medical quality assurance program, including a patient’s

medical records, on the grounds that the information was presented during meetings of a review body that are part of a medical

quality assurance program.

(i) REGULATIONS.—The Secretary of Defense shall prescribe

regulations to implement this section.

(j) DEFINITIONS.—In this section:

(1) The term ‘‘medical quality assurance program’’ means

any activity carried out before, on, or after November 14, 1986

by or for the Department of Defense to assess the quality of

medical care, including activities conducted by individuals,

military medical or dental treatment facility committees, or

other review bodies responsible for quality assurance, credentials, infection control, patient care assessment (including

treatment procedures, blood, drugs, and therapeutics), medical

records, health resources management review and identification and prevention of medical or dental incidents and risks.

(2) The term ‘‘medical quality assurance record’’ means the

proceedings, records, minutes, and reports that emanate from

quality assurance program activities described in paragraph (1)

and are produced or compiled by the Department of Defense as

part of a medical quality assurance program.

(3) The term ‘‘health care provider’’ means any military or

civilian health care professional who, under regulations of a

military department, is granted clinical practice privileges to

provide health care services in a military medical or dental

treatment facility or who is licensed or certified to perform

health care services by a governmental board or agency or professional health care society or organization.

(k) PENALTY.—Any person who willfully discloses a medical

quality assurance record other than as provided in this section,

knowing that such record is a medical quality assurance record,

shall be fined not more than $3,000 in the case of a first offense

and not more than $20,000 in the case of a subsequent offense.

(Added P.L. 99–661, § 705(a), Nov. 14, 1986, 100 Stat. 3902; amended P.L. 100–180, § 1231(5),

Dec. 4, 1987, 101 Stat. 1160; P.L. 101–189, § 653(f), Nov. 29, 1989, 103 Stat. 1463.)
71 § 1104 CH. 55—MEDICAL AND DENTAL CARE

§ 1103. Contracts for medical and dental care: State and

local preemption

(a) OCCURRENCE OF PREEMPTION.—A law or regulation of a

State or local government relating to health insurance, prepaid

health plans, or other health care delivery or financing methods

shall not apply to any contract entered into pursuant to this chapter by the Secretary of Defense or the administering Secretaries to

the extent that the Secretary of Defense or the administering Secretaries determine that—

(1) the State or local law or regulation is inconsistent with

a specific provision of the contract or a regulation promulgated

by the Secretary of Defense or the administering Secretaries

pursuant to this chapter; or

(2) the preemption of the State or local law or regulation

is necessary to implement or administer the provisions of the

contract or to achieve any other important Federal interest.

(b) EFFECT OF PREEMPTION.—In the case of the preemption

under subsection (a) of a State or local law or regulation regarding

financial solvency, the Secretary of Defense or the administering

Secretaries shall require an independent audit of the prime contractor of each contract that is entered into pursuant to this chapter and covered by the preemption. The audit shall be performed

by the Defense Contract Audit Agency.

(c) STATE DEFINED.—In this section, the term ‘‘State’’ includes

the District of Columbia, the Commonwealth of Puerto Rico, the

Commonwealth of the Northern Mariana Islands, and each Territory and possession of the United States.

(Added P.L. 100–180, § 725(a)(1), Dec. 4, 1987, 101 Stat. 1116; revised in its entirety P.L. 103–

160, § 715(a), Nov. 30, 1993, 107 Stat. 1690.)

§ 1104. Sharing of health-care resources with the Department of Veterans Affairs

(a) SHARING OF HEALTH-CARE RESOURCES.—Health-care resources of the Department of Defense shall be shared with healthcare resources of the Department of Veterans Affairs in accordance

with section 8111 of title 38 or under section 1535 of title 31.

(b) REIMBURSEMENT FROM CHAMPUS FUNDS.—Pursuant to an

agreement entered into under section 8111 of title 38 or section

1535 of title 31, the Secretary of a military department may reimburse the Secretary of Veterans Affairs from funds available for

that military department for the payment of medical care provided

under section 1079 or 1086 of this title.

(c) CHARGES.—The Secretary of Defense may prescribe by regulation a premium, deductible, copayment, or other charge for health

care provided to covered beneficiaries under this chapter pursuant

to an agreement entered into by the Secretary of a military department under section 8111 of title 38 or section 1535 of title 31.

(d) PROVISION OF SERVICES DURING WAR OR NATIONAL EMERGENCY.—Members of the armed forces on active duty during and

immediately following a period of war, or during and immediately

following a national emergency involving the use of the armed

forces in armed conflict, may be provided health-care services by

the Department of Veterans Affairs in accordance with section

8111A of title 38.
§ 1105 CH. 55—MEDICAL AND DENTAL CARE 72

(Added P.L. 101–189, § 772(a), Nov. 29, 1989, 103 Stat. 1477; amended P.L. 102–484, § 1052(14),

Oct. 23, 1992, 106 Stat. 2499; P.L. 103–35, § 201(c)(1), May 31, 1993, 107 Stat. 98; P.L. 107–

314, § 721(b), Dec. 2, 2002, 116 Stat. 2595.)

§ 1105. Specialized treatment facility program

(a) PROGRAM AUTHORIZED.—The Secretary of Defense may conduct a specialized treatment facility program pursuant to regulations prescribed by the Secretary of Defense. The Secretary shall

consult with the other administering Secretaries in prescribing regulations for the program and in conducting the program.

(b) FACILITIES AUTHORIZED TO BE USED.—Under the specialized treatment facility program, the Secretary may designate

health care facilities of the uniformed services and civilian health

care facilities as specialized treatment facilities.

(c) WAIVER OF NONEMERGENCY HEALTH CARE RESTRICTION.— Under the specialized treatment facility program, the Secretary

may waive, with regard to the provision of a particular service, the

40-mile radius restriction set forth in section 1079(a)(7) of this title

if the Secretary determines that the use of a different geographical

area restriction will result in a more cost-effective provision of the

service.

(d) CIVILIAN FACILITY SERVICE AREA.—For purposes of the specialized treatment facility program, the service area of a civilian

health care facility designated pursuant to subsection (b) shall be

comparable in size to the service areas of facilities of the uniformed

services.

(e) ISSUANCE OF NONAVAILABILITY OF HEALTH CARE STATE- MENTS.—A covered beneficiary who resides within the service area

of a specialized treatment facility designated under the specialized

treatment facility program may be required to obtain a nonavailability of health care statement in the case of a specialized service

offered by the facility in order for the covered beneficiary to receive

the service outside of the program.

(f) PAYMENT OF COSTS RELATED TO CARE IN SPECIALIZED

TREATMENT FACILITIES.—(1) Subject to paragraph (2), in connection

with the treatment of a covered beneficiary under the specialized

treatment facility program, the Secretary may provide the following benefits:

(A) Full or partial reimbursement of a member of the uniformed services for the reasonable expenses incurred by the

member in transporting a covered beneficiary to or from a

health care facility of the uniformed services or a civilian

health care facility at which specialized health care services

are provided pursuant to this chapter.

(B) Full or partial reimbursement of a person (including a

member of the uniformed services) for the reasonable expenses

of transportation, temporary lodging, and meals (not to exceed

a per diem rate determined in accordance with implementing

regulations) incurred by such person in accompanying a covered beneficiary as a nonmedical attendant to a health care facility referred to in subparagraph (A).

(C) In-kind transportation, lodging, or meals instead of reimbursements under subparagraph (A) or (B) for transportation, lodging, or meals, respectively.

(2) The Secretary may make reimbursements for or provide

transportation, lodging, and meals under paragraph (1) in the case
73 § 1107 CH. 55—MEDICAL AND DENTAL CARE

of a covered beneficiary only if the total cost to the Department of

Defense of doing so and of providing the health care in such case

is less than the cost to the Department of providing the health care

to the covered beneficiary by other means authorized under this

chapter.

(g) COVERED BENEFICIARY DEFINED.—In this section, the term

‘‘covered beneficiary’’ means a person covered under section 1079 or

1086 of this title.

(Added P.L. 102–190, § 715(a), Dec. 5, 1991, 105 Stat. 1403; revised in its entirety P.L. 103–

160, § 716(a)(1), Nov. 30, 1993, 107 Stat. 1690; amended P.L. 104–106, § 706, Feb. 10, 1996, 110

Stat. 373.)

§ 1106. Submittal of claims: standard form; time limits

(a) STANDARD FORM.—The Secretary of Defense, after consultation with the other administering Secretaries, shall prescribe by

regulation a standard form for the submission of claims for the

payment of health care services provided under this chapter.

(b) TIME FOR SUBMISSION.—A claim for payment for services

provided under this chapter shall be submitted as provided in such

regulations not later than one year after the services are provided.

(Added P.L. 102–190, § 716(a)(1), Dec. 5, 1991, 105 Stat. 1403; revised in its entirety P.L. 105–

85, § 738(a), Nov. 18, 1997, 111 Stat. 1815.)

§ 1107. Notice of use of an investigational new drug or a

drug unapproved for its applied use

(a) NOTICE REQUIRED.—(1) Whenever the Secretary of Defense

requests or requires a member of the armed forces to receive an investigational new drug or a drug unapproved for its applied use,

the Secretary shall provide the member with notice containing the

information specified in subsection (d).

(2) The Secretary shall also ensure that health care providers

who administer an investigational new drug or a drug unapproved

for its applied use, or who are likely to treat members who receive

such a drug, receive the information required to be provided under

paragraphs (3) and (4) of subsection (d).

(b) TIME OF NOTICE.—The notice required to be provided to a

member under subsection (a)(1) shall be provided before the investigational new drug or drug unapproved for its applied use is first

administered to the member.

(c) FORM OF NOTICE.—The notice required under subsection

(a)(1) shall be provided in writing.

(d) CONTENT OF NOTICE.—The notice required under subsection (a)(1) shall include the following:

(1) Clear notice that the drug being administered is an investigational new drug or a drug unapproved for its applied

use.

(2) The reasons why the investigational new drug or drug

unapproved for its applied use is being administered.

(3) Information regarding the possible side effects of the

investigational new drug or drug unapproved for its applied

use, including any known side effects possible as a result of the

interaction of such drug with other drugs or treatments being

administered to the members receiving such drug.

(4) Such other information that, as a condition of authorizing the use of the investigational new drug or drug unap-
§ 1107 CH. 55—MEDICAL AND DENTAL CARE 74

5Paragraphs (2) and (3) of section 731(a) of the Strom Thurmond National Defense Authorization Act for Fiscal Year 1999 (P.L. 105–261; 112 Stat. 2071) provide:

(2) Subsection (f ) of section 1107 of title 10, United States Code (as added by paragraph (1)),

shall apply to the administration of an investigational new drug or a drug unapproved for its

applied use to a member of the Armed Forces in connection with the member’s participation

in a particular military operation on or after [Oct. 17, 1998].

(3) A waiver of the requirement for prior consent imposed under the regulations required

under paragraph (4) of section 505(i) of the Federal Food, Drug, and Cosmetic Act (or under

any antecedent provision of law or regulations) that has been granted under that section (or

antecedent provision of law or regulations) before [Oct. 17, 1998,] for the administration of a

drug to a member of the Armed Forces in connection with the member’s participation in a particular military operation may be applied in that case after that date only if—

(A) the Secretary of Defense personally determines that the waiver is justifiable on each

ground on which the waiver was granted;

(B) the President concurs in that determination in writing; and

(C) the Secretary submits to the chairman and ranking minority member of each congressional committee referred to in section 1107(f )(4)(C) of title 10, United States Code (as

added by paragraph (1))—

(i) a notification of the waiver;

(ii) the President’s written concurrence; and

(iii) the Secretary’s justification for the request or for the requirement under subsection 1107(a) of such title for the member to receive the drug covered by the waiver.

proved for its applied use, the Secretary of Health and Human

Services may require to be disclosed.

(e) RECORDS OF USE.—The Secretary of Defense shall ensure

that the medical records of members accurately document—

(1) the receipt by members of any investigational new drug

or drug unapproved for its applied use; and

(2) the notice required by subsection (a)(1).

(f ) 5 LIMITATION AND WAIVER.—In the case of the administration of an investigational new drug or a drug unapproved for its applied use to a member of the armed forces in connection with the

member’s participation in a particular military operation, the requirement that the member provide prior consent to receive the

drug in accordance with the prior consent requirement imposed

under section 505(i)(4) of the Federal Food, Drug, and Cosmetic Act

(21 U.S.C. 355(i)(4)) may be waived only by the President. The

President may grant such a waiver only if the President determines, in writing, that obtaining consent—

(A) is not feasible;

(B) is contrary to the best interests of the member; or

(C) is not in the interests of national security.

(2) In making a determination to waive the prior consent requirement on a ground described in subparagraph (A) or (B) of

paragraph (1), the President shall apply the standards and criteria

that are set forth in the relevant FDA regulations for a waiver of

the prior consent requirement on that ground.

(3) The Secretary of Defense may request the President to

waive the prior consent requirement with respect to the administration of an investigational new drug or a drug unapproved for its

applied use to a member of the armed forces in connection with the

member’s participation in a particular military operation. With respect to any such administration—

(A) the Secretary may not delegate to any other official the

authority to request the President to waive the prior consent

requirement for the Department of Defense; and

(B) if the President grants the requested waiver, the Secretary shall submit to the chairman and ranking minority

member of each congressional defense committee a notification

of the waiver, together with the written determination of the
75 § 1107a CH. 55—MEDICAL AND DENTAL CARE

6Section 1603 of the National Defense Authorization Act for Fiscal Year 2004 (P.L. 108–136,

117 Stat. 1684) added section 1107a. Subsection (d) of such section 1603 provides:

(d) TERMINATION.—This section shall not be in effect (and the law shall read as if this section

were never enacted) as of the date on which, following enactment of the Project Bioshield Act

of 2003, the President submits to Congress a notification that the Project Bioshield Act of 2003

provides an effective emergency use authority with respect to members of the Armed Forces.

President under paragraph (1) and the Secretary’s justification

for the request or requirement under subsection (a) for the

member to receive the drug covered by the waiver.

(4) In this subsection:

(A) The term ‘‘relevant FDA regulations’’ means the regulations promulgated under section 505(i) of the Federal Food,

Drug, and Cosmetic Act (21 U.S.C. 355(i)).

(B) The term ‘‘prior consent requirement’’ means the requirement included in the relevant FDA regulations pursuant

to section 505(i)(4) of the Federal Food, Drug, and Cosmetic

Act (21 U.S.C. 355(i)(4)).

(g) DEFINITIONS.—In this section:

(1) The term ‘‘investigational new drug’’ means a drug covered by section 505(i) of the Federal Food, Drug, and Cosmetic

Act (21 U.S.C. 355(i)).

(2) The term ‘‘drug unapproved for its applied use’’ means

a drug administered for a use not described in the approved labeling of the drug under section 505 of the Federal Food, Drug,

and Cosmetic Act (21 U.S.C. 355).

(Added P.L. 105–85, § 766, Nov. 18, 1997, 111 Stat. 1827; amended P.L. 105–261, § 731(a)(1),

(b), Oct. 17, 1998, 112 Stat. 2070, 2071; P.L. 106–65, § 1067(1), Oct. 5, 1999, 113 Stat. 774; P.L.

108–136, § 1043(b)(7), Nov. 24, 2003, 117 Stat. 1611.)

§ 1107a. Emergency use products 6

(a) WAIVER BY THE PRESIDENT.—In the case of the administration of a product authorized for emergency use under section 564

of the Federal Food, Drug, and Cosmetic Act to members of the

armed forces, the condition described in section 564(e)(1)(A)(ii)(III)

of such Act and required under paragraph (1)(A) or (2)(A) of such

section 564(e), designed to ensure that individuals are informed of

an option to accept or refuse administration of a product, may be

waived only by the President only if the President determines, in

writing, that complying with such requirement is not feasible, is

contrary to the best interests of the members affected, or is not in

the interests of national security.

(b) PROVISION OF INFORMATION.—If the President, under subsection (a), waives the condition described in section

564(e)(1)(A)(ii)(III) of the Federal Food, Drug, and Cosmetic Act,

and if the Secretary of Defense, in consultation with the Secretary

of Health and Human Services, makes a determination that it is

not feasible based on time limitations for the information described

in section 564(e)(1)(A)(ii)(I) or (II) of such Act and required under

paragraph (1)(A) or (2)(A) of such section 564(e), to be provided to

a member of the armed forces prior to the administration of the

product, such information shall be provided to such member of the

armed forces (or next-of-kin in the case of the death of a member)

to whom the product was administered as soon as possible, but not

later than 30 days, after such administration. The authority provided for in this subsection may not be delegated. Information con-
§ 1108 CH. 55—MEDICAL AND DENTAL CARE 76

cerning the administration of the product shall be recorded in the

medical record of the member.

(c) APPLICABILITY OF OTHER PROVISIONS.—In the case of an authorization by the Secretary of Health and Human Services under

section 564(a)(1) of the Federal Food, Drug, and Cosmetic Act

based on a determination by the Secretary of Defense under section

564(b)(1)(B) of such Act, subsections (a) through (f) of section 1107

shall not apply to the use of a product that is the subject of such

authorization, within the scope of such authorization and while

such authorization is effective.

(Added P.L. 108–136, § 1603(b)(1), Nov. 24, 2003, 117 Stat. 1689.)

§ 1108. Health care coverage through Federal Employees

Health Benefits program: demonstration project

(a) FEHBP OPTION DEMONSTRATION.—The Secretary of Defense, after consulting with the other administering Secretaries,

shall enter into an agreement with the Office of Personnel Management to conduct a demonstration project (in this section referred to

as the ‘‘demonstration project’’) under which eligible beneficiaries

described in subsection (b) and residing within one of the areas covered by the demonstration project may enroll in health benefits

plans offered through the Federal Employees Health Benefits program under chapter 89 of title 5. The number of eligible beneficiaries and family members of such beneficiaries under subsection

(b)(2) who may be enrolled in health benefits plans during the enrollment period under subsection (d)(2) may not exceed 66,000.

(b) ELIGIBLE BENEFICIARIES; COVERAGE.—(1) An eligible beneficiary under this subsection is—

(A) a member or former member of the uniformed services

described in section 1074(b) of this title who is entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act (42 U.S.C. 1395c et seq.);

(B) an individual who is an unremarried former spouse of

a member or former member described in section 1072(2)(F) or

1072(2)(G));

(C) an individual who is—

(i) a dependent of a deceased member or former member described in section 1076(b) or 1076(a)(2)(B) of this

title or of a member who died while on active duty for a

period of more than 30 days; and

(ii) a member of family as defined in section 8901(5)

of title 5; or

(D) an individual who is—

(i) a dependent of a living member or former member

described in section 1076(b)(1) of this title who is entitled

to hospital insurance benefits under part A of title XVIII

of the Social Security Act, regardless of the member’s or

former member’s eligibility for such hospital insurance

benefits; and

(ii) a member of family as defined in section 8901(5)

of title 5.

(2) Eligible beneficiaries may enroll in a Federal Employees

Health Benefit plan under chapter 89 of title 5 under this section

for self-only coverage or for self and family coverage which includes
77 § 1108 CH. 55—MEDICAL AND DENTAL CARE

any dependent of the member or former member who is a family

member for purposes of such chapter.

(3) A person eligible for coverage under this subsection shall

not be required to satisfy any eligibility criteria specified in chapter

89 of title 5 (except as provided in paragraph (1)(C) or (1)(D)) as

a condition for enrollment in health benefits plans offered through

the Federal Employees Health Benefits program under the demonstration project.

(4) For purposes of determining whether an individual is a

member of family under paragraph (5) of section 8901 of title 5 for

purposes of paragraph (1)(C) or (1)(D), a member or former member

described in section 1076(b) or 1076(a)(2)(B) of this title shall be

deemed to be an employee under such section.

(5) An eligible beneficiary who is eligible to enroll in the Federal Employees Health Benefits program as an employee under

chapter 89 of title 5 is not eligible to enroll in a Federal Employees

Health Benefits plan under this section.

(c) AREA OF DEMONSTRATION PROJECT.—The Secretary of Defense and the Director of the Office of Personnel Management shall

jointly identify and select the geographic areas in which the demonstration project will be conducted. The Secretary and the Director shall establish at least six, but not more than ten, such demonstration areas. In establishing the areas, the Secretary and Director shall include—

(1) an area that includes the catchment area of one or

more military medical treatment facilities;

(2) an area that is not located in the catchment area of a

military medical treatment facility;

(3) an area in which there is a Medicare Subvention Demonstration project area under section 1896 of title XVIII of the

Social Security Act (42 U.S.C. 1395ggg); and

(4) not more than one area for each TRICARE region.

(d) DURATION OF DEMONSTRATION PROJECT.—(1) The Secretary

of Defense shall conduct the demonstration project during three

contract years under the Federal Employees Health Benefits program.

(2) Eligible beneficiaries shall, as provided under the agreement pursuant to subsection (a), be permitted to enroll in the demonstration project during an open enrollment period for the year

2000 (conducted in the fall of 1999). The demonstration project

shall terminate on December 31, 2002.

(e) PROHIBITION AGAINST USE OF MTFS AND ENROLLMENT

UNDER TRICARE.—Covered beneficiaries under this chapter who

are provided coverage under the demonstration project shall not be

eligible to receive care at a military medical treatment facility or

to enroll in a heath care plan under the TRICARE program.

(f ) TERM OF ENROLLMENT IN PROJECT.—(1) Subject to paragraphs (2) and (3), the period of enrollment of an eligible beneficiary who enrolls in the demonstration project during the open

enrollment period for the year 2000 shall be three years unless the

beneficiary disenrolls before the termination of the project.

(2) A beneficiary who elects to enroll in the project, and who

subsequently discontinues enrollment in the project before the end

of the period described in paragraph (1), shall not be eligible to reenroll in the project.
§ 1108 CH. 55—MEDICAL AND DENTAL CARE 78

(3) An eligible beneficiary enrolled in a Federal Employees

Health Benefits plan under this section may change health benefits

plans and coverage in the same manner as any other Federal Employees Health Benefits program beneficiary may change such

plans.

(g) EFFECT OF CANCELLATION.—The cancellation by an eligible

beneficiary of coverage under the Federal Employee Health Benefits program shall be irrevocable during the term of the demonstration project.

(h) SEPARATE RISK POOLS; CHARGES.—(1) The Director of the

Office of Personnel Management shall require health benefits plans

under chapter 89 of title 5 that participate in the demonstration

project to maintain a separate risk pool for purposes of establishing

premium rates for eligible beneficiaries who enroll in such a plan

in accordance with this section.

(2) The Director shall determine total subscription charges for

self only or for family coverage for eligible beneficiaries who enroll

in a health benefits plan under chapter 89 of title 5 in accordance

with this section. The subscription charges shall include premium

charges paid to the plan and amounts described in section 8906(c)

of title 5 for administrative expenses and contingency reserves.

(i) GOVERNMENT CONTRIBUTIONS.—The Secretary of Defense

shall be responsible for the Government contribution for an eligible

beneficiary who enrolls in a health benefits plan under chapter 89

of title 5 in accordance with this section, except that the amount

of the contribution may not exceed the amount of the Government

contribution which would be payable if the electing beneficiary

were an employee (as defined for purposes of such chapter) enrolled

in the same health benefits plan and level of benefits.

( j) REPORT REQUIREMENTS.—(1) The Secretary of Defense and

the Director of the Office of Personnel Management shall jointly

submit to Congress two reports containing the information described in paragraph (2). The first report shall be submitted not

later than the date that is 15 months after the date that the Secretary begins to implement the demonstration project. The second

report shall be submitted not later than December 31, 2002.

(2) The reports required by paragraph (1) shall include the following:

(A) Information on the number of eligible beneficiaries who

elect to participate in the demonstration project.

(B) An analysis of the percentage of eligible beneficiaries

who participate in the demonstration project as compared to

the percentage of covered beneficiaries under this chapter who

elect to enroll in a health care plan under such chapter.

(C) Information on eligible beneficiaries who elect to participate in the demonstration project and did not have Medicare Part B coverage before electing to participate in the

project.

(D) An analysis of the enrollment rates and cost of health

services provided to eligible beneficiaries who elect to participate in the demonstration project as compared with similarly

situated enrollees in the Federal Employees Health Benefits

program under chapter 89 of title 5.

(E) An analysis of how the demonstration project affects

the accessibility of health care in military medical treatment
79 § 1108 CH. 55—MEDICAL AND DENTAL CARE

facilities, and a description of any unintended effects on the

treatment priorities in those facilities in the demonstration

area.

(F) An analysis of any problems experienced by the Department of Defense in managing the demonstration project.

(G) A description of the effects of the demonstration project

on medical readiness and training of the Armed Forces at military medical treatment facilities located in the demonstration

area, and a description of the probable effects that making the

project permanent would have on the medical readiness and

training.

(H) An examination of the effects that the demonstration

project, if made permanent, would be expected to have on the

overall budget of the Department of Defense, the budget of the

Office of Personnel Management, and the budgets of individual

military medical treatment facilities.

(I) An analysis of whether the demonstration project affects the cost to the Department of Defense of prescription

drugs or the accessibility, availability, and cost of such drugs

to eligible beneficiaries.

(J) Any additional information that the Secretary of Defense or the Director of the Office of Personnel Management

considers appropriate to assist Congress in determining the viability of expanding the project to all Medicare-eligible members of the uniformed services and their dependents.

(K) Recommendations on whether eligible beneficiaries—

(i) should be given more than one chance to enroll in

the demonstration project under this section;

(ii) should be eligible to enroll in the project only during the first year following the date that the eligible beneficiary becomes eligible to receive hospital insurance benefits under part A of title XVIII of the Social Security Act;

or

(iii) should be eligible to enroll in the project only during the 2-year period following the date on which the beneficiary first becomes eligible to enroll in the project.

(k) COMPTROLLER GENERAL REPORT.—Not later than December

31, 2002, the Comptroller General shall submit to Congress a report addressing the same matters required to be addressed under

subsection ( j)(2). The report shall describe any limitations with respect to the data contained in the report as a result of the size and

design of the demonstration project.

(l) APPLICATION OF MEDIGAP PROTECTIONS TO DEMONSTRATION

PROJECT ENROLLEES.—(1) Subject to paragraph (2), the provisions

of section 1882(s)(3) (other than clauses (i) through (iv) of subparagraph (B)) and 1882(s)(4) of the Social Security Act shall apply to

enrollment (and termination of enrollment) in the demonstration

project under this section, in the same manner as they apply to enrollment (and termination of enrollment) with a Medicare+Choice

organization in a Medicare+Choice plan.

(2) In applying paragraph (1)—

(A) any reference in clause (v) or (vi) of section

1882(s)(3)(B) of such Act to 12 months is deemed a reference

to 36 months; and
§ 1109 CH. 55—MEDICAL AND DENTAL CARE 80

(B) the notification required under section 1882(s)(3)(D) of

such Act shall be provided in a manner specified by the Secretary of Defense in consultation with the Director of the Office

of Personnel Management.

(Added P.L. 105–261, § 721(a), Oct. 17, 1998, 112 Stat. 2061.)

§ 1109. Organ and tissue donor program

(a) RESPONSIBILITIES OF THE SECRETARY OF DEFENSE.—The

Secretary of Defense shall ensure that the advanced systems developed for recording armed forces members’ personal data and information (such as the SMARTCARD, MEDITAG, and Personal Information Carrier) include the capability to record organ and tissue

donation elections.

(b) RESPONSIBILITIES OF THE SECRETARIES OF THE MILITARY

DEPARTMENTS.—The Secretaries of the military departments shall

ensure that—

(1) appropriate information about organ and tissue

donation is provided—

(A) to each officer candidate during initial training;

and

(B) to each recruit—

(i) after completion by the recruit of basic training; and

(ii) before arrival of the recruit at the first duty

assignment of the recruit;

(2) members of the armed forces are given recurring, specific opportunities to elect to be organ or tissue donors during

service in the armed forces and upon retirement; and

(3) members of the armed forces electing to be organ or tissue donors are encouraged to advise their next of kin concerning the donation decision and any subsequent change of

that decision.

(c) RESPONSIBILITIES OF THE SURGEONS GENERAL OF THE

MILITARY DEPARTMENTS.—The Surgeons General of the military

departments shall ensure that—

(1) appropriate training is provided to enlisted and officer

medical personnel to facilitate the effective operation of organ

and tissue donation activities under garrison conditions and, to

the extent possible, under operational conditions; and

(2) medical logistical activities can, to the extent possible

without jeopardizing operational requirements, support an effective organ and tissue donation program.

(Added P.L. 105–261, § 741(b), Oct. 17, 1998, 112 Stat. 2073; amended P.L. 106–398,

§ 1[§ 1087(a)(8)], Oct. 30, 2000, 114 Stat. 1654, 1654A–290.)

§ 1110. Anthrax vaccine immunization program; procedures

for exemptions and monitoring reactions

(a) PROCEDURES FOR MEDICAL AND ADMINISTRATIVE EXEMPTIONS.—(1) The Secretary of Defense shall establish uniform procedures under which members of the armed forces may be exempted

from participating in the anthrax vaccine immunization program

for either administrative or medical reasons.

(2) The Secretaries of the military departments shall provide

for notification of all members of the armed forces of the procedures established pursuant to paragraph (1).
81 § 1110 CH. 55—MEDICAL AND DENTAL CARE

(b) SYSTEM FOR MONITORING ADVERSE REACTIONS.—(1) The

Secretary shall establish a system for monitoring adverse reactions

of members of the armed forces to the anthrax vaccine. That system shall include the following:

(A) Independent review of Vaccine Adverse Event Reporting System reports.

(B) Periodic surveys of personnel to whom the vaccine is

administered.

(C) A continuing longitudinal study of a pre-identified

group of members of the armed forces (including men and

women and members from all services).

(D) Active surveillance of a sample of members to whom

the anthrax vaccine has been administered that is sufficient to

identify, at the earliest opportunity, any patterns of adverse reactions, the discovery of which might be delayed by reliance

solely on the Vaccine Adverse Event Reporting System.

(2) The Secretary may extend or expand any ongoing or

planned study or analysis of trends in adverse reactions of members of the armed forces to the anthrax vaccine in order to meet

any of the requirements in paragraph (1).

(3) The Secretary shall establish guidelines under which members of the armed forces who are determined by an independent expert panel to be experiencing unexplained adverse reactions may

obtain access to a Department of Defense Center of Excellence

treatment facility for expedited treatment and follow up.

(Added P.L. 106–398, § 1[§ 751(b)(1)], Oct. 30, 2000, 114 Stat. 1654, 1654A–193.)
82

CHAPTER 56—DEPARTMENT OF DEFENSE MEDICAREELIGIBLE RETIREE HEALTH CARE FUND

Sec.

1111. Establishment and purpose of Fund; definitions; authority to enter into

agreements.

1112. Assets of Fund.

1113. Payments from the Fund.

1114. Board of Actuaries.

1115. Determination of contributions to the Fund.

1116. Payments into the Fund.

1117. Investment of assets of Fund.

§ 1111. Establishment and purpose of Fund; definitions; authority to enter into agreements

(a) There is established on the books of the Treasury a fund

to be known as the Department of Defense Medicare-Eligible Retiree Health Care Fund (hereinafter in this chapter referred to as

the ‘‘Fund’’), which shall be administered by the Secretary of the

Treasury. The Fund shall be used for the accumulation of funds in

order to finance on an actuarially sound basis liabilities of the Department of Defense under uniformed services retiree health care

programs for medicare-eligible beneficiaries.

(b) In this chapter:

(1) The term ‘‘uniformed services retiree health care programs’’ means the provisions of this title or any other provision

of law creating an entitlement to or eligibility for health care

for a member or former member of a participating uniformed

service who is entitled to retired or retainer pay, and an eligible dependent under such program.

(2) The term ‘‘eligible dependent’’ means a dependent described in section 1076(a)(2) (other than a dependent of a member on active duty), 1076(b), 1086(c)(2), or 1086(c)(3) of this

title.

(3) The term ‘‘medicare-eligible’’, with respect to any person, means entitled to benefits under part A of title XVIII of

the Social Security Act (42 U.S.C. 1395c et seq.).

(4) The term ‘‘participating uniformed service’’ means the

Army, Navy, Air Force, and Marine Corps, and any other uniformed service that is covered by an agreement entered into

under subsection (c).

(c) The Secretary of Defense shall enter into an agreement

with each other administering Secretary (as defined in section

1072(3) of this title) for participation in the Fund by a uniformed

service under the jurisdiction of that Secretary. The agreement

shall require that Secretary to determine contributions to the Fund

on behalf of the members of the uniformed service under the jurisdiction of that Secretary in a manner comparable to the determination with respect to contributions to the Fund made by the Sec-
83 § 1113 CH. 56—DOD MEDICARE-ELIGIBLE RETIREE HEALTH CARE FUND

1The Department of the Interior and Related Agencies Appropriations Act, 2003 (division F

of P.L. 108–3), provides, in a proviso in the paragraph in title II under the heading ‘‘Indian

Health Services’’ (117 Stat. 261), the following:

That notwithstanding any other provision of law, contributions authorized by 10 U.S.C. 1111

for the Uniformed Service of the Public Health Service shall be paid in fiscal year 2003 and

thereafter from the Department of Health and Human Services’ Retirement Pay and Medical

Benefits for Commissioned Officers account without charges billed to the Indian Health Service:

retary of Defense under section 1116 of this title, and such administering Secretary may make such contributions. 1

(Added P.L. 106–398, § 1[§ 713(a)(1)], Oct. 30, 2000, 114 Stat. 1654, 1654A–179; amended P.L.

107–107, §§ 711(a), (b)(1), (e)(1), (2), 1048(a)(12), Dec. 28, 2001, 115 Stat. 1164, 1165, 1166, 1223;

P.L. 107–314, § 704(b), Dec. 2, 2002, 116 Stat. 2584.)

§ 1112. Assets of Fund

There shall be deposited into the Fund the following, which

shall constitute the assets of the Fund:

(1) Amounts paid into the Fund under section 1116 of this

title.

(2) Any amount appropriated to the Fund.

(3) Any return on investment of the assets of the Fund.

(4) Amounts paid into the Fund pursuant to section

1111(c) of this title.

(Added P.L. 106–398, § 1[§ 713(a)(1)], Oct. 30, 2000, 114 Stat. 1654, 1654A–180; amended P.L.

107–107, § 711(b)(2), Dec. 28, 2001, 115 Stat. 1165.)

§ 1113. Payments from the Fund

(a) There shall be paid from the Fund amounts payable for the

costs of all uniformed service retiree health care programs for the

benefit of members or former members of a participating uniformed

service who are entitled to retired or retainer pay and are medicare

eligible, and eligible dependents who are medicare eligible.

(b) The assets of the Fund are hereby made available for payments under subsection (a).

(c)(1) In carrying out subsection (a), the Secretary of Defense

may transfer periodically from the Fund to applicable appropriations of the Department of Defense, or to applicable appropriations

of other departments or agencies, such amounts as the Secretary

determines necessary to cover the costs chargeable to those appropriations for uniformed service retiree health care programs for

beneficiaries under those programs who are medicare-eligible. Such

transfers may include amounts necessary for the administration of

such programs. Amounts so transferred shall be merged with and

be available for the same purposes and for the same time period

as the appropriation to which transferred. Upon a determination

that all or part of the funds transferred from the Fund are not necessary for the purposes for which transferred, such amounts may

be transferred back to the Fund. This transfer authority is in addition to any other transfer authority that may be available to the

Secretary.

(2) A transfer from the Fund under paragraph (1) may not be

made to an appropriation after the end of the second fiscal year

after the fiscal year that the appropriation is available for obligation. A transfer back to the Fund under paragraph (1) may not be

made after the end of the second fiscal year after the fiscal year
§ 1114 CH. 56—DOD MEDICARE-ELIGIBLE RETIREE HEALTH CARE FUND 84

for which the appropriation to which the funds were originally

transferred is available for obligation.

(d) The Secretary of Defense shall by regulation establish the

method or methods for calculating amounts to be transferred under

subsection (c). Such method or methods may be based (in whole or

in part) on a proportionate share of the volume (measured as the

Secretary determines appropriate) of health care services provided

or paid for under uniformed service retiree health care programs

for beneficiaries under those programs who are medicare-eligible in

relation to the total volume of health care services provided or paid

for under Department of Defense health care programs.

(e) The regulations prescribed by the Secretary under subsection (d) shall be provided to the Comptroller General not less

than 60 days before such regulations become effective. The Comptroller General shall, not later than 30 days after receiving such

regulations, report to the Secretary of Defense and Congress on the

adequacy and appropriateness of the regulations.

(f) If the Secretary of Defense enters into an agreement with

another administering Secretary pursuant to section 1111(c), the

Secretary of Defense may take the actions described in subsections

(c), (d), and (e) on behalf of the beneficiaries and programs of the

other participating uniformed service.

(Added P.L. 106–398, § 1[§ 713(a)(1)], Oct. 30, 2000, 114 Stat. 1654, 1654A–180; amended P.L.

107–107, § 711(c), Dec. 28, 2001, 115 Stat. 1165.)

§ 1114. Board of Actuaries

(a)(1) There is established in the Department of Defense a Department of Defense Medicare-Eligible Retiree Health Care Board

of Actuaries (hereinafter in this chapter referred to as the ‘‘Board’’).

The Board shall consist of three members who shall be appointed

by the Secretary of Defense from among qualified professional actuaries who are members of the Society of Actuaries.

(2)(A) Except as provided in subparagraph (B), the members of

the Board shall serve for a term of 15 years, except that a member

of the Board appointed to fill a vacancy occurring before the end

of the term for which his predecessor was appointed shall only

serve until the end of such term. A member may serve after the

end of his term until his successor has taken office. A member of

the Board may be removed by the Secretary of Defense for misconduct or failure to perform functions vested in the Board, and for

no other reason.

(B) Of the members of the Board who are first appointed under

this paragraph, one each shall be appointed for terms ending five,

ten, and 15 years, respectively, after the date of appointment, as

designated by the Secretary of Defense at the time of appointment.

(3) A member of the Board who is not otherwise an employee

of the United States is entitled to receive pay at the daily equivalent of the annual rate of basic pay of the highest rate of basic pay

under the General Schedule of subchapter III of chapter 53 of title

5, for each day the member is engaged in the performance of duties

vested in the Board, and is entitled to travel expenses, including

a per diem allowance, in accordance with section 5703 of title 5.
85 § 1115 CH. 56—DOD MEDICARE-ELIGIBLE RETIREE HEALTH CARE FUND

(b) The Board shall report to the Secretary of Defense annually

on the actuarial status of the Fund and shall furnish its advice and

opinion on matters referred to it by the Secretary.

(c) The Board shall review valuations of the Fund under section 1115(c) of this title and shall report periodically, not less than

once every four years, to the President and Congress on the status

of the Fund. The Board shall include in such reports recommendations for such changes as in the Board’s judgment are necessary to

protect the public interest and maintain the Fund on a sound actuarial basis.

(Added P.L. 106–398, § 1[§ 713(a)(1)], Oct. 30, 2000, 114 Stat. 1654, 1654A–180; amended P.L.

107–107, § 1048(a)(12), Dec. 28, 2001, 115 Stat. 1223.)

§ 1115. Determination of contributions to the Fund

(a) The Board shall determine the amount that is the present

value (as of October 1, 2002) of future benefits payable from the

Fund that are attributable to service in the participating uniformed

services performed before October 1, 2002. That amount is the

original unfunded liability of the Fund. The Board shall determine

the period of time over which the original unfunded liability should

be liquidated and shall determine an amortization schedule for the

liquidation of such liability over that period. Contributions to the

Fund for the liquidation of the original unfunded liability in accordance with such schedule shall be made as provided in section

1116(c) of this title.

(b)(1) The Secretary of Defense shall determine each year, in

sufficient time for inclusion in budget requests for the following fiscal year, the total amount of Department of Defense contributions

to be made to the Fund during that fiscal year under section

1116(a) of this title. That amount shall be the sum of the following:

(A) The product of—

(i) the current estimate of the value of the single level

dollar amount to be determined under subsection (c)(1)(A)

at the time of the next actuarial valuation under subsection (c); and

(ii) the expected average force strength during that fiscal year for members of the uniformed services under the

jurisdiction of the Secretary of Defense on active duty

(other than active duty for training) and full-time National

Guard duty (other than full-time National Guard duty for

training only).

(B) The product of—

(i) the current estimate of the value of the single level

dollar amount to be determined under subsection (c)(1)(B)

at the time of the next actuarial valuation under subsection (c); and

(ii) the expected average force strength during that fiscal year for members of the Ready Reserve of the uniformed services under the jurisdiction of the Secretary of

Defense (other than members on full-time National Guard

duty other than for training) who are not otherwise described in subparagraph (A)(ii).

(2) The amount determined under paragraph (1) for any fiscal

year is the amount needed to be appropriated to the Department
§ 1115 CH. 56—DOD MEDICARE-ELIGIBLE RETIREE HEALTH CARE FUND 86

of Defense (or to the other executive department having jurisdiction

over the participating uniformed service) for that fiscal year for

payments to be made to the Fund during that year under section

1116(a) of this title. The President shall include not less than the

full amount so determined in the budget transmitted to Congress

for that fiscal year under section 1105 of title 31. The President

may comment and make recommendations concerning any such

amount.

(c)(1) Not less often than every four years, the Secretary of Defense shall carry out an actuarial valuation of the Fund. Each such

actuarial valuation shall include—

(A) a determination (using the aggregate entry-age normal

cost method) of a single level dollar amount for members of the

participating uniformed services on active duty (other than active duty for training) or full-time National Guard duty (other

than full-time National Guard duty for training only); and

(B) a determination (using the aggregate entry-age normal

cost method) of a single level dollar amount for members of the

Ready Reserve of the participating uniformed services (other

than members on full-time National Guard duty other than for

training) who are not otherwise described by subparagraph (A).

Such single level dollar amounts shall be used for the purposes of

subsection (b) and section 1116(a) of this title. The Secretary of Defense may determine a separate single level dollar amount under

subparagraph (A) or (B) for any participating uniformed service, if,

in the judgment of the Secretary, such a determination would

produce a more accurate and appropriate actuarial valuation for

that uniformed service.

(2) If at the time of any such valuation there has been a

change in benefits under the uniformed services retiree health care

programs for medicare-eligible beneficiaries that has been made

since the last such valuation and such change in benefits increases

or decreases the present value of amounts payable from the Fund,

the Secretary of Defense shall determine an amortization methodology and schedule for the amortization of the cumulative unfunded

liability (or actuarial gain to the Fund) created by such change and

any previous such changes so that the present value of the sum of

the amortization payments (or reductions in payments that would

otherwise be made) equals the cumulative increase (or decrease) in

the present value of such amounts.

(3) If at the time of any such valuation the Secretary of Defense determines that, based upon changes in actuarial assumptions since the last valuation, there has been an actuarial gain or

loss to the Fund, the Secretary shall determine an amortization

methodology and schedule for the amortization of the cumulative

gain or loss to the Fund created by such change in assumptions

and any previous such changes in assumptions through an increase

or decrease in the payments that would otherwise be made to the

Fund.

(4) If at the time of any such valuation the Secretary of Defense determines that, based upon the Fund’s actuarial experience

(other than resulting from changes in benefits or actuarial assumptions) since the last valuation, there has been an actuarial gain or

loss to the Fund, the Secretary shall determine an amortization
87 § 1116 CH. 56—DOD MEDICARE-ELIGIBLE RETIREE HEALTH CARE FUND

2The Department of the Interior and Related Agencies Appropriations Act, 2003 (division F

of P.L. 108–3), provides, in a proviso in the paragraph in title II under the heading ‘‘Indian

Health Services’’ (117 Stat. 261), the following:

That heretofore and hereafter the provisions of 10 U.S.C. 1116 shall not apply to the Indian

Health Service:

methodology and schedule for the amortization of the cumulative

gain or loss to the Fund created by such actuarial experience and

any previous actuarial experience through an increase or decrease

in the payments that would otherwise be made to the Fund.

(5) Contributions to the Fund in accordance with amortization

schedules under paragraphs (2), (3), and (4) shall be made as provided in section 1116(c) of this title.

(d) All determinations under this section shall be made using

methods and assumptions approved by the Board of Actuaries (including assumptions of interest rates and medical inflation) and in

accordance with generally accepted actuarial principles and practices.

(e) The Secretary of Defense shall provide for the keeping of

such records as are necessary for determining the actuarial status

of the Fund.

(Added P.L. 106–398, § 1[§ 713(a)(1)], Oct. 30, 2000, 114 Stat. 1654, 1654A–181; amended P.L.

107–107, § 711(b)(3), (e)(1), Dec. 28, 2001, 115 Stat. 1165, 1166; P.L. 108–136, §§ 722(a), (c),

1045(a)(3), Nov. 24, 2003, 117 Stat. 1532, 1612.)

§ 1116. Payments into the Fund 2

(a) The Secretary of Defense shall pay into the Fund at the end

of each month as the Department of Defense contribution to the

Fund for that month the amount that, subject to subsection (b), is

the sum of the following:

(1) The product of—

(A) the monthly dollar amount determined using all

the methods and assumptions approved for the most recent (as of the first day of the current fiscal year) actuarial

valuation under section 1115(c)(1)(A) of this title (except

that any statutory change in the uniformed services retiree

health care programs for medicare-eligible beneficiaries

that is effective after the date of that valuation and on or

before the first day of the current fiscal year shall be used

in such determination); and

(B) the total end strength for that month for members

of the uniformed services under the jurisdiction of the Secretary of Defense on active duty (other than active duty for

training) and full-time National Guard duty (other than

full-time National Guard duty for training only).

(2) The product of—

(A) the level monthly dollar amount determined using

all the methods and assumptions approved for the most recent (as of the first day of the current fiscal year) actuarial

valuation under section 1115(c)(1)(B) of this title (except

that any statutory change in the uniformed services retiree

health care programs for medicare-eligible beneficiaries

that is effective after the date of that valuation and on or

before the first day of the current fiscal year shall be used

in such determination); and
§ 1116 CH. 56—DOD MEDICARE-ELIGIBLE RETIREE HEALTH CARE FUND 88

(B) the total end strength for that month for members

of the Ready Reserve of the uniformed services under the

jurisdiction of the Secretary of Defense other than members on full-time National Guard duty (other than for

training) who are not otherwise described in paragraph

(1)(B).

(b) If an actuarial valuation referred to in paragraph (1) or (2)

of subsection (a) has been calculated as a separate single level dollar amount for a participating uniformed service under section

1115(c)(1) of this title, the administering Secretary for the department in which such uniformed service is operating shall calculate

the amount under such paragraph separately for such uniformed

service. If the administering Secretary is not the Secretary of Defense, the administering Secretary shall notify the Secretary of Defense of the amount so calculated. To determine a single amount

for the purpose of paragraph (1) or (2) of subsection (a), as the case

may be, the Secretary of Defense shall aggregate the amount calculated under this subsection for a uniformed service for the purpose of such paragraph with the amount or amounts calculated

(whether separately or otherwise) for the other uniformed services

for the purpose of such paragraph.

(c)(1) At the beginning of each fiscal year the Secretary of the

Treasury shall promptly pay into the Fund from the General Fund

of the Treasury the amount certified to the Secretary by the Secretary of Defense under paragraph (3). Such payment shall be the

contribution to the Fund for that fiscal year required by sections

1115(a) and 1115(c) of this title.

(2) At the beginning of each fiscal year the Secretary of Defense shall determine the sum of the following:

(A) The amount of the payment for that year under the

amortization schedule determined by the Board of Actuaries

under section 1115(a) of this title for the amortization of the

original unfunded liability of the Fund.

(B) The amount (including any negative amount) for that

year under the most recent amortization schedule determined

by the Secretary of Defense under section 1115(c)(2) of this

title for the amortization of any cumulative unfunded liability

(or any gain) to the Fund resulting from changes in benefits.

(C) The amount (including any negative amount) for that

year under the most recent amortization schedule determined

by the Secretary of Defense under section 1115(c)(3) of this

title for the amortization of any cumulative actuarial gain or

loss to the Fund resulting from actuarial assumption changes.

(D) The amount (including any negative amount) for that

year under the most recent amortization schedule determined

by the Secretary of Defense under section 1115(c)(4) of this

title for the amortization of any cumulative actuarial gain or

loss to the Fund resulting from actuarial experience.

(3) The Secretary of Defense shall promptly certify the amount

determined under paragraph (2) each year to the Secretary of the

Treasury.

(d) Amounts paid into the Fund under subsection (a) shall be

paid from funds available for the pay of members of the partici-
89 § 1117 CH. 56—DOD MEDICARE-ELIGIBLE RETIREE HEALTH CARE FUND

pating uniformed services under the jurisdiction of the respective

administering Secretaries.

(Added P.L. 106–398, § 1[§ 713(a)(1)], Oct. 30, 2000, 114 Stat. 1654, 1654A–182; amended P.L.

107–107, §§ 711(b)(4), (d), (e)(1), 1048(a)(13), Dec. 28, 2001, 115 Stat. 1165, 1166, 1223; P.L. 107–

314, § 704(a), Dec. 2, 2002, 116 Stat. 2584; P.L. 108–136, § 722(b), Nov. 24, 2003, 117 Stat. 1532.)

§ 1117. Investment of assets of Fund

The Secretary of the Treasury shall invest such portion of the

Fund as is not in the judgment of the Secretary of Defense required

to meet current withdrawals. Such investments shall be in public

debt securities with maturities suitable to the needs of the Fund,

as determined by the Secretary of Defense, and bearing interest at

rates determined by the Secretary of the Treasury, taking into consideration current market yields on outstanding marketable obligations of the United States of comparable maturities. The income on

such investments shall be credited to and form a part of the Fund.

(Added P.L. 106–398, § 1[§ 713(a)(1)], Oct. 30, 2000, 114 Stat. 1654, 1654A–184.)

91

CHAPTER 58—BENEFITS AND SERVICES FOR MEMBERS

BEING SEPARATED OR RECENTLY SEPARATED

* * * * * * *

§ 1142. Preseparation counseling; transmittal of medical

records to Department of Veterans Affairs

(a) REQUIREMENT.—(1) Within the time periods specified in

paragraph (3), the Secretary concerned shall (except as provided in

paragraph (4)) provide for individual preseparation counseling of

each member of the armed forces whose discharge or release from

active duty is anticipated as of a specific date. A notation of the

provision of such counseling with respect to each matter specified

in subsection (b), signed by the member, shall be placed in the

service record of each member receiving such counseling.

(2) In carrying out this section, the Secretary concerned may

use the services available under section 1144 of this title.

(3)(A) In the case of an anticipated retirement, preseparation

counseling shall commence as soon as possible during the 24-month

period preceding the anticipated retirement date. In the case of a

separation other than a retirement, preseparation counseling shall

commence as soon as possible during the 12-month period preceding the anticipated date. Except as provided in subparagraph

(B), in no event shall preseparation counseling commence later

than 90 days before the date of discharge or release.

(B) In the event that a retirement or other separation is unanticipated until there are 90 or fewer days before the anticipated retirement or separation date, preseparation counseling shall begin

as soon as possible within the remaining period of service.

(4)(A) Subject to subparagraph (B), the Secretary concerned

shall not provide preseparation counseling to a member who is

being discharged or released before the completion of that member’s first 180 days of active duty.

(B) Subparagraph (A) shall not apply in the case of a member

who is being retired or separated for disability.

(b) MATTERS TO BE COVERED BY COUNSELING.—Counseling

under this section shall include the following:

(1) A discussion of the educational assistance benefits to

which the member is entitled under the Montgomery GI Bill

and other educational assistance programs because of the

member’s service in the armed forces.

(2) A description (to be developed with the assistance of

the Secretary of Veterans Affairs) of the compensation and vocational rehabilitation benefits to which the member may be

entitled under laws administered by the Secretary of Veterans

Affairs, if the member is being medically separated or is being

retired under chapter 61 of this title.
§ 1145 CH. 58—BENEFITS & SERVICES FOR SEPARATED MEMBERS 92

(3) An explanation of the procedures for and advantages of

affiliating with the Selected Reserve.

(4) Information concerning Government and private-sector

programs for job search and job placement assistance, including the public and community service jobs program carried out

under section 1143a of this title, and information regarding the

placement programs established under sections 1152 and 1153

of this title and the Troops-to-Teachers Program Act of 1999

(20 U.S.C. 9301 et seq.).

(5) If the member has a spouse, job placement counseling

for the spouse.

(6) Information concerning the availability of relocation

assistance services and other benefits and services available to

persons leaving military service, as provided under section

1144 of this title.

(7) Information concerning the availability of medical and

dental coverage following separation from active duty, including the opportunity to elect into the conversion health policy

provided under section 1145 of this title.

(8) Counseling (for the member and dependents) on the

effect of career change on individuals and their families.

(9) Financial planning assistance.

(10) The creation of a transition plan for the member to

attempt to achieve the educational, training, and employment

objectives of the member and, if the member has a spouse, the

spouse of the member.

(c) TRANSMITTAL OF MEDICAL INFORMATION TO DEPARTMENT OF

VETERANS AFFAIRS.—In the case of a member being medically separated or being retired under chapter 61 of this title, the Secretary

concerned shall ensure (subject to the consent of the member) that

a copy of the member’s service medical record (including any results of a Physical Evaluation Board) is transmitted to the Secretary of Veterans Affairs within 60 days of the separation or retirement.

(Added P.L. 101–510, § 502(a)(1), Nov. 5, 1990, 104 Stat. 1552; amended P.L. 102–190,

§ 1061(a)(5), 105 Stat. 1472; P.L. 102–484, §§ 4401, 4441(b), 4462(b), Oct. 23, 1992, 106 Stat.

2701, 2730, 2740; P.L. 103–35, § 201(i)(1), May 31, 1993, 107 Stat. 100; P.L. 103–160, § 1332(c),

Nov. 30, 1993, 107 Stat. 1797; P.L. 106–398, § 1[§ 1087(a)(9)], Oct. 30, 2000, 114 Stat. 1654,

1654A–290; P.L. 107–103, § 302(a), Dec. 27, 2001, 115 Stat. 991.)

* * * * * * *

§ 1145. Health benefits

(a) TRANSITIONAL HEALTH CARE.—(1) For the applicable time

period described in paragraph (3), a member of the armed forces

who is separated from active duty as described in paragraph (2)

(and the dependents of the member) shall be entitled to receive—

(A) medical and dental care under section 1076 of this title

in the same manner as a dependent described in subsection

(a)(2) of such section; and

(B) health benefits contracted under the authority of section 1079(a) of this title and subject to the same rates and conditions as apply to persons covered under that section.

(2) This subsection applies to the following members of the

armed forces:
93 § 1145 CH. 58—BENEFITS & SERVICES FOR SEPARATED MEMBERS

1Section 704 of the National Defense Authorization Act for Fiscal Year 2004 (Public Law 108–

136; 117 Stat. 1527) provides:

SEC. 704. TEMPORARY EXTENSION OF TRANSITIONAL HEALTH CARE BENEFITS.

(a) EXTENSION.—Subject to subsection (b), and notwithstanding section 1117 of the Emergency

Supplemental Appropriations Act for Defense and for the Reconstruction of Iraq and Afghanistan, 2004, during the period beginning on the date of the enactment of this Act [Nov. 24, 2003]

and ending on December 31, 2004, section 1145(a) of title 10, United States Code, shall be administered by substituting for paragraph (3) the following:

‘‘(3) Transitional health care for a member under subsection (a) shall be available for 180

days beginning on the date on which the member is separated from active duty.’’.

(b) EFFECTIVE DATE.—(1) Subsection (a) shall apply with respect to separations from active

duty that take effect on or after the date of the enactment of this Act.

(2) Beginning on January 1, 2005, the period for which a member is provided transitional

health care benefits under section 1145(a) of title 10, United States Code, shall be adjusted as

necessary to comply with the limits provided under paragraph (3) of such section. 2Section 4408(c) of the National Defense Authorization Act for Fiscal Year 1993 (P.L. 102–

484; 106 Stat. 2712) provides:

(c) TERMINATION OF APPLICABILITY OF OTHER CONVERSION HEALTH POLICIES.—(1) No person

may purchase a conversion health policy under section 1145(b) or 1086a of title 10, United

States Code, on or after October 1, 1994. A person covered by such a conversion health policy

on that date may cancel that policy and enroll in a health benefits plan under section 1078a

of such title.

(2) No person may be covered concurrently by a conversion health policy under section 1145(b)

or 1086a of such title and a health benefits plan under section 1078a of such title.

(A) A member who is involuntarily separated from active

duty.

(B) A member of a reserve component who is separated

from active duty to which called or ordered in support of a contingency operation if the active duty is active duty for a period

of more than 30 days.

(C) A member who is separated from active duty for which

the member is involuntarily retained under section 12305 of

this title in support of a contingency operation.

(D) A member who is separated from active duty served

pursuant to a voluntary agreement of the member to remain

on active duty for a period of less than one year in support of

a contingency operation.

(3) 1 Transitional health care shall be available under subsection (a) for a specified time period beginning on the date on

which the member is separated as follows:

(A) For members separated with less than six years of active service, 60 days.

(B) For members separated with six or more years of active service, 120 days.

(b) CONVERSION HEALTH POLICIES.—(1) The Secretary of Defense shall inform each member referred to in subsection (a) before

the date of the member’s discharge or release from active duty of

the availability for purchase by the member of a conversion health

policy for the member and the dependents of that member. A conversion health policy offered under this paragraph shall provide

coverage for not less than an 18-month period.2

(2) If a member referred to in subsection (a) purchases a conversion health policy during the period applicable to the member

(or within a reasonable time after that period as prescribed by the

Secretary of Defense), the Secretary shall provide health care, or

pay the costs of health care provided, to the member and the dependents of the member—

(A) during the 18-month period beginning on the date on

which coverage under the conversion health policy begins; and
§ 1145 CH. 58—BENEFITS & SERVICES FOR SEPARATED MEMBERS 94

(B) for a condition (including pregnancy) that exists on

such date and for which care is not provided under the policy

solely on the grounds that the condition is a preexisting condition.

(3) The Secretary of Defense may arrange for the provision of

health care described in paragraph (2) through a contract with the

insurer offering the conversion health policy.

(4) If the Secretary of Defense is unable, within a reasonable

time, to enter into a contract with a private insurer to provide the

conversion health policy required under paragraph (1) at a rate not

to exceed the payment required under section 8905a(d)(1)(A) of title

5 for comparable coverage, the Secretary shall offer such a policy

under the Civilian Health and Medical Program of the Uniformed

Services. Subject to paragraph (5), a member purchasing a policy

from the Secretary shall be required to pay into the Military

Health Care Account or other appropriate account an amount equal

to the sum of—

(A) the individual and Government contributions which

would be required in the case of a person enrolled in a health

benefits plan contracted for under section 1079 of this title;

and

(B) an amount necessary for administrative expenses, but

not to exceed two percent of the amount under subparagraph

(A).

(5) The amount paid by a member who purchases a conversion

health policy from the Secretary of Defense under paragraph (4)

may not exceed the payment required under section 8905a(d)(1)(A)

of title 5 for comparable coverage.

(6) In order to reduce premiums required under paragraph (4),

the Secretary of Defense may offer a conversion health policy that,

with respect to mental health services, offers reduced coverage and

increased cost-sharing by the purchaser.

(c) HEALTH CARE FOR CERTAIN SEPARATED MEMBERS NOT OTHERWISE ELIGIBLE.—(1) Consistent with the authority of the Secretary concerned to designate certain classes of persons as eligible

to receive health care at a military medical facility, the Secretary

concerned should consider authorizing, on an individual basis in

cases of hardship, the provision of that care for a member who is

separated from the armed forces, and is ineligible for transitional

health care under subsection (a) or does not obtain a conversion

health policy (or a dependent of the member).

(2) The Secretary concerned shall give special consideration to

requests for such care in cases in which the condition for which

treatment is required was incurred or aggravated by the member

or the dependent before the date of the separation of the member,

particularly if the condition is a result of the particular circumstances of the service of the member.

(d) DEFINITION.—In this section, the term ‘‘conversion health

policy’’ means a health insurance policy with a private insurer, developed through negotiations between the Secretary of Defense and

a private insurer, that is available for purchase by or for the use

of a person who is no longer a member of the armed forces or a

covered beneficiary.
95 § 1145 CH. 58—BENEFITS & SERVICES FOR SEPARATED MEMBERS

(e) COAST GUARD.—The Secretary of Homeland Security shall

implement this section for the members of the Coast Guard and

their dependents.

(Added P.L. 101–510, § 502(a)(1), Nov. 5, 1990, 104 Stat. 1555; amended P.L. 102–484, § 4407(a),

Oct. 23, 1992, 106 Stat. 2707; P.L. 103–160, § 561(i), Nov. 30, 1993, 107 Stat. 1668; P.L. 103–

337, § 542(a)(4), Oct. 5, 1994, 108 Stat. 2768; P.L. 105–261, § 561(h), Oct. 17, 1998, 112 Stat.

2026; P.L. 106–398, § 1[§ 571(h)], Oct. 30, 2000, 114 Stat. 1654, 1654A–134; P.L. 107–107,

§ 736(a), (b), Dec. 28, 2001, 115 Stat. 1172; P.L. 107–296, § 1704(b)(1), Nov. 25, 2002, 116 Stat.

2314; P.L. 107–314, § 706(a), (b), Dec. 2, 2002, 116 Stat. 2585.)

* * * * * * *

97

CHAPTER 59—SEPARATION

* * * * * * *

§ 1178. System and procedures for tracking separations resulting from refusal to participate in anthrax vaccine immunization program

(a) REQUIREMENT TO ESTABLISH SYSTEM.—The Secretary of

each military department shall establish a system for tracking, recording, and reporting separations of members of the armed forces

under the Secretary’s jurisdiction that result from procedures initiated as a result of a refusal to participate in the anthrax vaccine

immunization program.

(b) REPORT.—The Secretary of Defense shall consolidate the information recorded under the system described in subsection (a)

and shall submit to the Committees on Armed Services of the Senate and the House of Representatives not later than April 1 of each

year a report on such information. Each such report shall include

a description of—

(1) the number of members separated, categorized by military department, grade, and active-duty or reserve status; and

(2) any other information determined appropriate by the

Secretary.

(Added P.L. 106–398, § 1[§ 751(a)(1)], Oct. 30, 2000, 114 Stat. 1654, 1654A–193.)

* * * * * * *

99

SELECTED HEALTH-RELATED PROVISIONS OF DEFENSE

AUTHORIZATION ACTS

101

NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEAR 2004

(P.L. 108–136, approved Nov. 24, 2003)

DIVISION A—DEPARTMENT OF

DEFENSE AUTHORIZATIONS

* * * * * * *

TITLE VII—HEALTH CARE PROVISIONS

* * * * * * *

Subtitle C—Planning, Programming, and Management

* * * * * * *

SEC. 723. ø10 U.S.C. 1073 note¿ SURVEYS ON CONTINUED VIABILITY OF

TRICARE STANDARD.

(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 accessto-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.
Sec. 723 P.L. 108–136 (DEFENSE AUTHORIZATION, FY04) 102

(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 1072(4) of title 10, United States Code.
103 Sec. 724 P.L. 108–136 (DEFENSE AUTHORIZATION, FY04)

(2) The term ‘‘United States’’ means the United States (as

defined in section 101(a) of title 10, United States Code), its

possessions (as defined in such section), and the Commonwealth of Puerto Rico.

SEC. 724. ø10 U.S.C. 1079 note¿ PLAN FOR PROVIDING HEALTH COVERAGE INFORMATION TO MEMBERS, FORMER MEMBERS,

AND DEPENDENTS ELIGIBLE FOR CERTAIN HEALTH BENEFITS.

(a) HEALTH INFORMATION PLAN REQUIRED.—The Secretary of

Defense shall develop a plan to—

(1) ensure that each household that includes one or more

eligible persons is provided information concerning—

(A) the extent of health coverage provided by sections

1079 or 1086 of title 10, United States Code, for each such

person;

(B) the costs, including the limits on such costs, that

each such person is required to pay for such health coverage;

(C) sources of information for locating TRICARE-authorized providers in the household’s locality; and

(D) methods to obtain assistance in resolving difficulties encountered with billing, payments, eligibility, locating TRICARE-authorized providers, collection actions, and

such other issues as the Secretary considers appropriate;

(2) provide mechanisms to ensure that each eligible person

has access to information identifying TRICARE-authorized providers in the person’s locality who have agreed to accept new

patients under section 1079 or 1086 of title 10, United States

Code, and to ensure that such information is periodically updated;

(3) provide mechanisms to ensure that each eligible person

who requests assistance in locating a TRICARE-authorized

provider is provided such assistance;

(4) provide information and recruitment materials and programs aimed at attracting participation of health care providers as necessary to meet health care access requirements for

all eligible persons; and

(5) provide mechanisms to allow for the periodic identification by the Department of Defense of the number and locality

of eligible persons who may intend to rely on TRICARE-authorized providers for health care services.

(b) IMPLEMENTATION OF PLAN.—The Secretary of Defense shall

implement the plan required by subsection (a) with respect to any

contract entered into by the Department of Defense after May 31,

2003, for managed health care.

(c) DEFINITIONS.—In this section:

(1) The term ‘‘eligible person’’ means a person eligible for

health benefits under section 1079 or 1086 of title 10, United

States Code.

(2) The term ‘‘TRICARE-authorized provider’’ means a facility, doctor, or other provider of health care services—

(A) that meets the licensing and credentialing certification requirements in the State where the services are

rendered;
Sec. 727 P.L. 108–136 (DEFENSE AUTHORIZATION, FY04) 104

(B) that meets requirements under regulations relating to TRICARE for the type of health care services rendered; and

(C) that has accepted reimbursement by the Secretary

of Defense as payment for services rendered during the 12-

month period preceding the date of the most recently updated provider information provided to households under

the plan required by subsection (a).

(d) SUBMISSION OF PLAN.—Not later than March 31, 2004, the

Secretary shall submit to the Committees on Armed Services of the

Senate and House of Representatives the plan required by subsection (a), together with a schedule for implementation of the

plan.

* * * * * * *

SEC. 727. ø38 U.S.C. 320 note¿ JOINT PROGRAM FOR DEVELOPMENT

AND EVALUATION OF INTEGRATED HEALING CARE PRACTICES FOR MEMBERS OF THE ARMED FORCES AND VETERANS.

(a) PROGRAM.—The Secretary of Defense and the Secretary of

Veterans Affairs may conduct a program to develop and evaluate

integrated healing care practices for members of the Armed Forces

and veterans. Any such program shall be carried out through the

Department of Veterans Affairs-Department of Defense Joint Executive Committee established under section 320 of title 38, United

States Code.

(b) SOURCE OF DOD FUNDS.—Amounts authorized to be appropriated by this Act for the Defense Health Program may be used

for the program under subsection (a).
105

BOB STUMP NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL

YEAR 2003

(P.L. 107–314, approved Dec. 2, 2002)

DIVISION A—DEPARTMENT OF

DEFENSE AUTHORIZATIONS

* * * * * * *

TITLE VII—HEALTH CARE PROVISIONS

* * * * * * *

Subtitle A—Health Care Program Improvements

* * * * * * *

SEC. 708. ø10 U.S.C. 1071 note¿ ACCESS TO HEALTH CARE SERVICES

FOR BENEFICIARIES ELIGIBLE FOR TRICARE AND DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE.

(a) REQUIREMENT TO ESTABLISH PROCESS.—(1) The Secretary

of Defense shall prescribe in regulations a process for resolving

issues relating to patient safety and continuity of care for covered

beneficiaries who are concurrently entitled to health care under the

TRICARE program and eligible for health care services provided by

the Department of Veterans Affairs. The Secretary shall—

(A) ensure that the process provides for coordination of,

and access to, health care from the two sources in a manner

that prevents diminution of access to health care from either

source; and

(B) in consultation with the Secretary of Veterans Affairs,

prescribe a clear definition of an ‘‘episode of care’’ for use in the

resolution of patient safety and continuity of care issues under

such process.

(2) Not later than May 1, 2003, the Secretary shall submit to

the Committees on Armed Services of the Senate and of the House

of Representatives a report describing the process prescribed under

paragraph (1).

(3) While prescribing the process under paragraph (1) and

upon completion of the report under paragraph (2), the Secretary

shall provide to the Comptroller General information that would be

relevant in carrying out the study required by subsection (b).

(b) COMPTROLLER GENERAL STUDY AND REPORT.—(1) The

Comptroller General shall conduct a study of the health care issues

of covered beneficiaries described in subsection (a). The study shall

include the following:

(A) An analysis of whether covered beneficiaries who seek

services through the Department of Veterans Affairs are re-
Sec. 722 P.L. 107–314 (DEFENSE AUTHORIZATION, FY03) 106

ceiving needed health care services in a timely manner from

the Department of Veterans Affairs, as compared to the timeliness of the care available to covered beneficiaries under

TRICARE Prime (as set forth in access to care standards under

TRICARE program policy that are applicable to the care being

sought).

(B) An evaluation of the quality of care for covered beneficiaries who do not receive needed services from the Department of Veterans Affairs within a time period that is comparable to the time period provided for under such access to

care standards and who then must seek alternative care under

the TRICARE program.

(C) Recommendations to improve access to, and timeliness

and quality of, care for covered beneficiaries described in subsection (a).

(D) An evaluation of the feasibility and advisability of

making access to care standards applicable jointly under the

TRICARE program and the Department of Veterans Affairs

health care system.

(E) A review of the process prescribed by the Secretary of

Defense under subsection (a) to determine whether the process

ensures the adequacy and quality of the health care services

provided to covered beneficiaries under the TRICARE program

and through the Department of Veterans Affairs, together with

timeliness of access to such services and patient safety.

(2) Not later than 60 days after the congressional committees

specified in subsection (a)(2) receive the report required under that

subsection, the Comptroller General shall submit to those committees a report on the study conducted under this subsection.

(c) DEFINITIONS.—In this section:

(1) The term ‘‘covered beneficiary’’ has the meaning provided by section 1072(5) of title 10, United States Code.

(2) The term ‘‘TRICARE program’’ has the meaning provided by section 1072(7) of such title.

(3) The term ‘‘TRICARE Prime’’ has the meaning provided

by section 1097a(f) of such title.

* * * * * * *

Subtitle C—Department of Defense-Department of Veterans

Affairs Health Resources Sharing

SEC. 721. REVISED COORDINATION AND SHARING GUIDELINES.

øOmitted (amended in its entirety 38 U.S.C. 8111)¿

SEC. 722. ø38 U.S.C. 8111 note¿ HEALTH CARE RESOURCES SHARING

AND COORDINATION PROJECT.

(a) ESTABLISHMENT.—(1) The Secretary of Veterans Affairs and

the Secretary of Defense shall conduct a health care resources

sharing project to serve as a test for evaluating the feasibility, and

the advantages and disadvantages, of measures and programs designed to improve the sharing and coordination of health care and

health care resources between the Department of Veterans Affairs

and the Department of Defense. The project shall be carried out,

as a minimum, at the sites identified under subsection (b).

(2) Reimbursement between the two Departments with respect

to the project under this section shall be made in accordance with
107 Sec. 722 P.L. 107–314 (DEFENSE AUTHORIZATION, FY03)

the provisions of section 8111(e)(2) of title 38, United States Code,

as amended by section 721(a).

(b) SITE IDENTIFICATION.—(1) Not later than 90 days after the

date of the enactment of this Act, the Secretaries shall jointly identify not less than three sites for the conduct of the project under

this section.

(2) For purposes of this section, a site at which the resource

sharing project shall be carried out is an area in the United States

in which—

(A) one or more military treatment facilities and one or

more VA health care facilities are situated in relative proximity to each other, including facilities engaged in joint ventures as of the date of the enactment of this Act; and

(B) for which an agreement to coordinate care and programs for patients at those facilities could be implemented not

later than October 1, 2004.

(c) CONDUCT OF PROJECT.—(1) At sites at which the project is

conducted, the Secretaries shall provide a test of a coordinated

management system for the military treatment facilities and VA

health care facilities participating in the project. Such a coordinated management system for a site shall include at least one of

the elements specified in paragraph (2), and each of the elements

specified in that paragraph must be included in the coordinated

management system for at least one of the participating sites.

(2) Elements of a coordinated management system referred to

in paragraph (1) are the following:

(A) A budget and financial management system for those

facilities that—

(i) provides managers with information about the costs

of providing health care by both Departments at the site;

and

(ii) allows managers to assess the advantages and disadvantages (in terms of relative costs, benefits, and opportunities) of using resources of either Department to provide or enhance health care to beneficiaries of either Department.

(B) A coordinated staffing and assignment system for the

personnel (including contract personnel) employed at or assigned to those facilities, including clinical practitioners of either Department.

(C) Medical information and information technology systems for those facilities that—

(i) are compatible with the purposes of the project;

(ii) communicate with medical information and information technology systems of corresponding elements of

those facilities; and

(iii) incorporate minimum standards of information

quality that are at least equivalent to those adopted for

the Departments at large in their separate health care systems.

(d) AUTHORITY TO WAIVE CERTAIN ADMINISTRATIVE POLICIES.—

(1)(A) In order to carry out subsection (c), the Secretary of Defense

may, in the Secretary’s discretion, waive any administrative policy

of the Department of Defense otherwise applicable to that subsection that specifically conflicts with the purposes of the project,
Sec. 722 P.L. 107–314 (DEFENSE AUTHORIZATION, FY03) 108

in instances in which the Secretary determines that the waiver is

necessary for the purposes of the project.

(B) In order to carry out subsection (c), the Secretary of Veterans Affairs may, in the Secretary’s discretion, waive any administrative policy of the Department of Veterans Affairs otherwise applicable to that subsection that specifically conflicts with the purposes of the project, in instances in which the Secretary determines

that the waiver is necessary for the purposes of the project.

(C) The two Secretaries shall establish procedures for resolving

disputes that may arise from the effects of policy changes that are

not covered by other agreements or existing procedures.

(2) No waiver under paragraph (1) may alter any labor-management agreement in effect as of the date of the enactment of this

Act or adopted by either Department during the period of the

project.

(e) USE BY DOD OF CERTAIN TITLE 38 PERSONNEL AUTHORI- TIES.—(1) In order to carry out subsection (c), the Secretary of Defense may apply to civilian personnel of the Department of Defense

assigned to or employed at a military treatment facility participating in the project any of the provisions of subchapters I, III, and

IV of chapter 74 of title 38, United States Code, determined appropriate by the Secretary.

(2) For purposes of paragraph (1), any reference in chapter 74

of title 38, United States Code—

(A) to the ‘‘Secretary’’ or the ‘‘Under Secretary for Health’’

shall be treated as referring to the Secretary of Defense; and

(B) to the ‘‘Veterans Health Administration’’ shall be treated as referring to the Department of Defense.

(f) FUNDING.—From amounts available for health care for a fiscal year, each Secretary shall make available to carry out the

project not less than—

(1) $3,000,000 for fiscal year 2003;

(2) $6,000,000 for fiscal year 2004; and

(3) $9,000,000 for each succeeding year during which the

project is in effect.

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

(1) The term ‘‘military treatment facility’’ means a medical

facility under the jurisdiction of the Secretary of a military department.

(2) The term ‘‘VA health care facility’’ means a facility

under the jurisdiction of the Veterans Health Administration of

the Department of Veterans Affairs.

(h) PERFORMANCE REVIEW.—(1) The Comptroller General shall

provide for an annual on-site review at each of the project locations

selected by the Secretaries under this section.

(2) Not later than 90 days after completion of the annual review under paragraph (1), the Comptroller General shall submit a

report on such review to the Committees on Armed Services and

Veterans’ Affairs of the Senate and House of Representatives.

(3) Each such report shall include the following:

(A) The strategic mission coordination between shared activities.

(B) The accuracy and validity of performance data used to

evaluate sharing performance and changes in standards of care

or services at the shared facilities.
109 Sec. 724 P.L. 107–314 (DEFENSE AUTHORIZATION, FY03)

(C) A statement that all appropriated funds designated for

sharing activities are being used for direct support of sharing

initiatives.

(D) Recommendations concerning continuance of the

project at each site for the succeeding 12-month period.

(4) Whenever there is a recommendation under paragraph

(3)(D) to discontinue a resource sharing project under this section,

the two Secretaries shall act upon that recommendation as soon as

practicable.

(5) In the initial report under this subsection, the Comptroller

General shall validate the baseline information used for comparative analysis.

(i) TERMINATION.—(1) The project, and the authority provided

by this section, shall terminate on September 30, 2007.

(2) The two Secretaries jointly may terminate the performance

of the project at any site when the performance of the project at

that site fails to meet performance expectations of the Secretaries,

based on recommendations from the Comptroller General under

subsection (h) or on other information available to the Secretaries

to warrant such action.

SEC. 723. REPORT ON IMPROVED COORDINATION AND SHARING OF

HEALTH CARE AND HEALTH CARE RESOURCES FOLLOWING DOMESTIC ACTS OF TERRORISM OR DOMESTIC

USE OF WEAPONS OF MASS DESTRUCTION.

(a) JOINT REVIEW.—The Secretary of Defense and the Secretary of Veterans Affairs shall jointly review the adequacy of current processes and existing statutory authorities and policy governing the capability of the Department of Defense and the Department of Veterans Affairs to provide health care to members of the

Armed Forces following domestic acts of terrorism or domestic use

of weapons of mass destruction, both before and after any declaration of national emergency. Such review shall include a determination of the adequacy of current authorities in providing for the coordination and sharing of health care resources between the two

Departments in such cases, particularly before the declaration of a

national emergency.

(b) REPORT TO CONGRESS.—The two Secretaries shall include a

joint report on the review under subsection (a), including any recommended legislative changes, shall be submitted to Congress as

part of the fiscal year 2004 budget submission to Congress.

SEC. 724. ø10 U.S.C. 1074g note¿ INTEROPERABILITY OF DEPARTMENT

OF VETERANS AFFAIRS AND DEPARTMENT OF DEFENSE

PHARMACY DATA SYSTEMS.

(a) INTEROPERABILITY.—The Secretary of Veterans Affairs and

the Secretary of Defense shall seek to ensure that on or before October 1, 2004, the Department of Veterans Affairs pharmacy data

system and the Department of Defense pharmacy data system

(known as the ‘‘Pharmacy Data Transaction System’’) are interoperable for both Department of Defense beneficiaries and Department

of Veterans Affairs beneficiaries by achieving real-time interface,

data exchange, and checking of prescription drug data of outpatients, and using national standards for the exchange of outpatient medication information.

(b) ALTERNATIVE REQUIREMENT.—If the interoperability specified in subsection (a) is not achieved by October 1, 2004, as deter-
Sec. 725 P.L. 107–314 (DEFENSE AUTHORIZATION, FY03) 110

mined jointly by the Secretary of Defense and the Secretary of Veterans Affairs, the Secretary of Veterans Affairs shall adopt the Department of Defense Pharmacy Data Transaction System for use by

the Department of Veterans Affairs health care system. Such system shall be fully operational not later than October 1, 2005.

(c) IMPLEMENTATION FUNDING FOR ALTERNATIVE REQUIREMENT.—The Secretary of Defense shall transfer to the Secretary of

Veterans Affairs, or shall otherwise bear the cost of, an amount

sufficient to cover three-fourths of the cost to the Department of

Veterans Affairs for computer programming activities and relevant

staff training expenses related to implementation of subsection (b).

Such amount shall be determined in such manner as agreed to by

the two Secretaries.

SEC. 725. ø10 U.S.C. 1094a note¿ JOINT PILOT PROGRAM FOR PROVIDING GRADUATE MEDICAL EDUCATION AND TRAINING

FOR PHYSICIANS.

(a) IN GENERAL.—The Secretary of Defense and the Secretary

of Veterans Affairs shall jointly carry out a pilot program under

which graduate medical education and training is provided to military physicians and physician employees of the Department of Defense and the Department of Veterans Affairs through one or more

programs carried out in military medical treatment facilities of the

Department of Defense and medical centers of the Department of

Veterans Affairs. The pilot program shall begin not later than January 1, 2003.

(b) COST-SHARING AGREEMENT.—The Secretaries shall enter

into an agreement for carrying out the pilot program. The agreement shall establish means for each Secretary to assist in paying

the costs, with respect to individuals under the jurisdiction of that

Secretary, incurred by the other Secretary in providing medical

education and training under the pilot program.

(c) USE OF EXISTING AUTHORITIES.—To carry out the pilot program, the Secretary of Defense and the Secretary of Veterans Affairs may use authorities provided to them under this subtitle, section 8111 of title 38, United States Code (as amended by section

721(a)), and other laws relating to the furnishing or support of

medical education and the cooperative use of facilities.

(d) TERMINATION OF PROGRAM.—The pilot program under this

section shall terminate on July 31, 2008.

(e) REPEAL OF SUPERSEDED PROVISION.—øOmitted (repealed

section 738 of P.L. 107–107)¿

SEC. 726. REPEAL OF CERTAIN LIMITS ON DEPARTMENT OF VETERANS AFFAIRS RESOURCES.

øOmitted (amended section 8110(a)(1) of title 38, U.S.C.)¿
111

NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEAR 2002

(P.L. 107–107, approved Dec. 28, 2001)

DIVISION A—DEPARTMENT OF

DEFENSE AUTHORIZATIONS

* * * * * * *

TITLE VII—HEALTH CARE PROVISIONS

* * * * * * *

SEC. 734. ø10 U.S.C. 1071 note¿ PILOT PROGRAM PROVIDING FOR DEPARTMENT OF VETERANS AFFAIRS SUPPORT IN THE PERFORMANCE OF SEPARATION PHYSICAL EXAMINATIONS.

(a) AUTHORITY.—The Secretary of Defense and the Secretary of

Veterans Affairs may jointly carry out a pilot program under which

the Secretary of Veterans Affairs may perform the physical examinations required for members of the uniformed services separating

from the uniformed services who are in one or more geographic

areas designated for the pilot program by the Secretaries.

(b) REIMBURSEMENT.—The Secretary of Defense shall reimburse the Secretary of Veterans Affairs for the cost incurred by the

Secretary of Veterans Affairs in performing, under the pilot program, the elements of physical examination that are required by

the Secretary concerned in connection with the separation of a

member of a uniformed service. Reimbursements shall be paid out

of funds available for the performance of separation physical examinations of members of that uniformed service in facilities of the

uniformed services.

(c) AGREEMENT.—(1) If the Secretary of Defense and the Secretary of Veterans Affairs carry out the pilot program authorized

by this section, the Secretaries shall enter into an agreement specifying the geographic areas in which the pilot program is carried out

and the means for making reimbursement payments under subsection (b).

(2) The other administering Secretaries shall also enter into

the agreement to the extent that the Secretary of Defense determines necessary to apply the pilot program, including the requirement for reimbursement, to the uniformed services not under the

jurisdiction of the Secretary of a military department.

(d) CONSULTATION REQUIREMENT.—In developing and carrying

out the pilot program, the Secretary of Defense shall consult with

the other administering Secretaries.

(e) PERIOD OF PROGRAM.—The Secretary of Defense and the

Secretary of Veterans Affairs may carry out the pilot program

under this section beginning not later than July 1, 2002, and terminating on December 31, 2005.
Sec. 734 P.L. 107–107 (DEFENSE AUTHORIZATION, FY02) 112

(f) REPORTS.—(1) If the Secretary of Defense and the Secretary

of Veterans Affairs carry out the pilot program authorized by this

section—

(A) not later than January 31, 2004, the Secretaries shall

jointly submit to Congress an interim report on the conduct of

the pilot program; and

(B) not later than March 1, 2005, the Secretaries shall

jointly submit to Congress a final report on the conduct of the

pilot program.

(2) Reports under this subsection shall include the Secretaries’

assessment, as of the date of the report, of the efficacy of the performance of separation physical examinations as provided for under

the pilot program.

(g) DEFINITIONS.—In this section:

(1) The term ‘‘administering Secretaries’’ has the meaning

given that term in section 1072(3) of title 10, United States

Code.

(2) The term ‘‘Secretary concerned’’ has the meaning given

that term in section 101(5) of title 37, United States Code.
113

1Section 711 of the National Defense Authorization Act for Fiscal Year 2004 (Public Law 108–

136; 117 Stat. 1530; 10 U.S.C. 1092 note) provides as follows:

SEC. 711. ACCELERATION OF IMPLEMENTATION OF CHIROPRACTIC HEALTH

CARE FOR MEMBERS ON ACTIVE DUTY.

The Secretary of Defense shall accelerate the implementation of the plan required by section

702 of the Floyd D. Spence National Defense Authorization Act for Fiscal Year 2001 (Public Law

106–398; 114 Stat. 1654A–173) (relating to chiropractic health care services and benefits), with

a goal of completing implementation of the plan by October 1, 2005.

FLOYD D. SPENCE NATIONAL DEFENSE AUTHORIZATION ACT FOR

FISCAL YEAR 2001

(As enacted by P.L. 106–398, approved Oct. 30, 2000)

DIVISION A—DEPARTMENT OF

DEFENSE AUTHORIZATIONS

* * * * * * *

TITLE VII—HEALTH CARE PROVISIONS

* * * * * * *

SEC. 702. ø10 U.S.C. 1092 note¿ CHIROPRACTIC HEALTH CARE FOR

MEMBERS ON ACTIVE DUTY. 1

(a) PLAN REQUIRED.—(1) Not later than March 31, 2001, the

Secretary of Defense shall complete development of a plan to provide chiropractic health care services and benefits, as a permanent

part of the Defense Health Program (including the TRICARE program), for all members of the uniformed services who are entitled

to care under section 1074(a) of title 10, United States Code.

(2) The plan shall provide for the following:

(A) Access, at designated military medical treatment facilities, to the scope of chiropractic services as determined by the

Secretary, which includes, at a minimum, care for neuro-musculoskeletal conditions typical among military personnel on active duty.

(B) A detailed analysis of the projected costs of fully integrating chiropractic health care services into the military

health care system.

(C) An examination of the proposed military medical treatment facilities at which such services would be provided.

(D) An examination of the military readiness requirements

for chiropractors who would provide such services.

(E) An examination of any other relevant factors that the

Secretary considers appropriate.

(F) Phased-in implementation of the plan over a 5-year period, beginning on October 1, 2001.

(b) CONSULTATION REQUIREMENTS.—The Secretary of Defense

shall consult with the other administering Secretaries described in
Sec. 721 P.L. 106–398 (DEFENSE AUTHORIZATION, FY01) 114

section 1073 of title 10, United States Code, and the oversight advisory committee established under section 731 of the National Defense Authorization Act for Fiscal Year 1995 (Public Law 103–337;

10 U.S.C. 1092 note) regarding the following:

(1) The development and implementation of the plan required under subsection (a).

(2) Each report that the Secretary is required to submit to

Congress regarding the plan.

(3) The selection of the military medical treatment facilities at which the chiropractic services described in subsection

(a)(2)(A) are to be provided.

(c) CONTINUATION OF CURRENT SERVICES.—Until the plan required under subsection (a) is implemented, the Secretary shall

continue to furnish the same level of chiropractic health care services and benefits under the Defense Health Program that is provided during fiscal year 2000 at military medical treatment facilities that provide such services and benefits.

(d) REPORT REQUIRED.—Not later than January 31, 2001, the

Secretary of Defense shall submit a report on the plan required

under subsection (a), together with appropriate appendices and attachments, to the Committees on Armed Services of the Senate and

the House of Representatives.

(e) GAO REPORTS.—The Comptroller General shall monitor the

development and implementation of the plan required under subsection (a), including the administration of services and benefits

under the plan, and periodically submit to the committees referred

to in subsection (d) written reports on such development and implementation.

* * * * * * *

Subtitle C—TRICARE Program

SEC. 721. ø10 U.S.C. 1073 note¿ IMPROVEMENT OF ACCESS TO HEALTH

CARE UNDER THE TRICARE PROGRAM.

(a) WAIVER OF NONAVAILABILITY STATEMENT OR

PREAUTHORIZATION.—In the case of a covered beneficiary under

TRICARE Standard pursuant to chapter 55 of title 10, 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
115 Sec. 723 P.L. 106–398 (DEFENSE AUTHORIZATION, FY01)

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.

* * * * * * *

SEC. 723. ø10 U.S.C. 1073 note¿ MODERNIZATION OF TRICARE BUSINESS

PRACTICES AND INCREASE OF USE OF MILITARY TREATMENT FACILITIES.

(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;
Sec. 724 P.L. 106–398 (DEFENSE AUTHORIZATION, FY01) 116

(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 1072 of title 10, United

States Code.

SEC. 724. ø10 U.S.C. 1073 note¿ EXTENSION OF TRICARE MANAGED

CARE SUPPORT CONTRACTS.

(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.

* * * * * * *

SEC. 727. CLAIMS PROCESSING IMPROVEMENTS.

Beginning on the date of the enactment of this Act, the Secretary of Defense shall, to the maximum extent practicable, take

all necessary actions to implement the following improvements

with respect to processing of claims under the TRICARE program:

(1) Use of the TRICARE encounter data information system rather than the health care service record in maintaining

information on covered beneficiaries under chapter 55 of title

10, United States Code.

(2) Elimination of all delays in payment of claims to health

care providers that may result from the development of the

health care service record or TRICARE encounter data information.
117 Sec. 731 P.L. 106–398 (DEFENSE AUTHORIZATION, FY01)

(3) Requiring all health care providers under the

TRICARE program that the Secretary determines are high-volume providers to submit claims electronically.

(4) Processing 50 percent of all claims by health care providers and institutions under the TRICARE program by electronic means.

(5) Authorizing managed care support contractors under

the TRICARE program to require providers to access information on the status of claims through the use of telephone automated voice response units.

* * * * * * *

Subtitle D—Demonstration Projects

SEC. 731. ø10 U.S.C. 1092 note¿ DEMONSTRATION PROJECT FOR EXPANDED ACCESS TO MENTAL HEALTH COUNSELORS.

(a) REQUIREMENT TO CONDUCT DEMONSTRATION PROJECT.—

The Secretary of Defense shall conduct a demonstration project

under which licensed and certified professional mental health counselors who meet eligibility requirements for participation as providers under the Civilian Health and Medical Program of the Uniformed Services (hereafter in this section referred to as

‘‘CHAMPUS’’) or the TRICARE program may provide services to

covered beneficiaries under chapter 55 of title 10, United States

Code, without referral by physicians or adherence to supervision

requirements.

(b) DURATION AND LOCATION OF PROJECT.—The Secretary shall

conduct the demonstration project required by subsection (a)—

(1) during the 2-year period beginning October 1, 2001;

and

(2) in one established TRICARE region.

(c) REGULATIONS.—The Secretary shall prescribe regulations

regarding participation in the demonstration project required by

subsection (a).

(d) PLAN FOR PROJECT.—Not later than March 31, 2001, the

Secretary shall submit to the Committees on Armed Services of the

Senate and the House of Representatives a plan to carry out the

demonstration project. The plan shall include, but not be limited to,

a description of the following:

(1) The TRICARE region in which the project will be conducted.

(2) The estimated funds required to carry out the demonstration project.

(3) The criteria for determining which professional mental

health counselors will be authorized to participate under the

demonstration project.

(4) The plan of action, including critical milestone dates,

for carrying out the demonstration project.

(e) REPORT.—Not later than February 1, 2003, the Secretary

shall submit to Congress a report on the demonstration project carried out under this section. The report shall include the following:

(1) A description of the extent to which expenditures for

reimbursement of licensed or certified professional mental
Sec. 732 P.L. 106–398 (DEFENSE AUTHORIZATION, FY01) 118

health counselors change as a result of allowing the independent practice of such counselors.

(2) Data on utilization and reimbursement regarding nonphysician mental health professionals other than licensed or

certified professional mental health counselors under

CHAMPUS and the TRICARE program.

(3) Data on utilization and reimbursement regarding physicians who make referrals to, and supervise, mental health

counselors.

(4) A description of the administrative costs incurred as a

result of the requirement for documentation of referral to mental health counselors and supervision activities for such counselors.

(5) For each of the categories described in paragraphs (1)

through (4), a comparison of data for a 1-year period for the

area in which the demonstration project is being implemented

with corresponding data for a similar area in which the demonstration project is not being implemented.

(6) A description of the ways in which allowing for independent reimbursement of licensed or certified professional

mental health counselors affects the confidentiality of mental

health and substance abuse services for covered beneficiaries

under CHAMPUS and the TRICARE program.

(7) A description of the effect, if any, of changing reimbursement policies on the health and treatment of covered

beneficiaries under CHAMPUS and the TRICARE program, including a comparison of the treatment outcomes of covered

beneficiaries who receive mental health services from licensed

or certified professional mental health counselors acting under

physician referral and supervision, other non-physician mental

health providers recognized under CHAMPUS and the

TRICARE program, and physicians, with treatment outcomes

under the demonstration project allowing independent practice

of professional counselors on the same basis as other non-physician mental health providers.

(8) The effect of policies of the Department of Defense on

the willingness of licensed or certified professional mental

health counselors to participate as health care providers in

CHAMPUS and the TRICARE program.

(9) Any policy requests or recommendations regarding

mental health counselors made by health care plans and managed care organizations participating in CHAMPUS or the

TRICARE program.

SEC. 732. ø10 U.S.C. 1092 note¿ TELERADIOLOGY DEMONSTRATION

PROJECT.

(a) AUTHORITY TO CONDUCT PROJECT.—(1) The Secretary of

Defense may conduct a demonstration project for the purposes of

increasing efficiency of operations with respect to teleradiology at

military medical treatment facilities, supporting remote clinics, and

increasing coordination with respect to teleradiology between such

facilities and clinics. Under the project, a military medical treatment facility and each clinic supported by such facility shall be

linked by a digital radiology network through which digital radi-
119 Sec. 741 P.L. 106–398 (DEFENSE AUTHORIZATION, FY01)

ology X-rays may be sent electronically from clinics to the military

medical treatment facility.

(2) The demonstration project may be conducted at several

multispecialty tertiary-care military medical treatment facilities affiliated with a university medical school. One of such facilities shall

be supported by at least 5 geographically dispersed remote clinics

of the Departments of the Army, Navy, and Air Force, and clinics

of the Department of Veterans Affairs and the Coast Guard. Another of such facilities shall be in an underserved rural geographic

region served under established telemedicine contracts between the

Department of Defense, the Department of Veterans Affairs, and a

local university.

(b) DURATION OF PROJECT.—The Secretary shall conduct the

project during the 2-year period beginning on the date of the enactment of this Act.

SEC. 733. ø10 U.S.C. 1071 note¿ HEALTH CARE MANAGEMENT DEMONSTRATION PROGRAM.

(a) ESTABLISHMENT.—The Secretary of Defense shall carry out

a demonstration program on health care management to explore

opportunities for improving the planning, programming, budgeting

systems, and management of the Department of Defense health

care system.

(b) TEST MODELS.—Under the demonstration program, the Secretary shall test the use of the following planning and management

models:

(1) A health care simulation model for studying alternative

delivery policies, processes, organizations, and technologies.

(2) A health care simulation model for studying long term

disease management.

(c) DEMONSTRATION SITES.—The Secretary shall test each

model separately at one or more sites.

(d) PERIOD FOR PROGRAM.—The demonstration program shall

begin not later than 180 days after the date of the enactment of

this Act and shall terminate on December 31, 2003.

(e) REPORT.—The Secretary of Defense shall submit a report on

the demonstration program to the Committees on Armed Services

of the Senate and the House of Representatives not later than

March 15, 2004. The report shall include the Secretary’s assessment of the value of incorporating the use of the tested planning

and management models throughout the planning, programming,

budgeting systems, and management of the Department of Defense

health care system.

(f ) FUNDING.—Of the amount authorized to be appropriated

under section 301(22), $6,000,000 shall be available for the demonstration program under this section.

* * * * * * *

Subtitle E—Joint Initiatives With Department of Veterans

Affairs

SEC. 741. ø38 U.S.C. 8111 note¿ VA-DOD SHARING AGREEMENTS FOR

HEALTH SERVICES.

(a) PRIMACY OF SHARING AGREEMENTS.—The Secretary of Defense shall—
Sec. 742 P.L. 106–398 (DEFENSE AUTHORIZATION, FY01) 120

(1) give full force and effect to any agreement into which

the Secretary or the Secretary of a military department entered under section 8111 of title 38, United States Code, or

under section 1535 of title 31, United States Code, which was

in effect on September 30, 1999; and

(2) ensure that the Secretary of the military department

concerned directly reimburses the Secretary of Veterans Affairs

for any services or resources provided under such agreement in

accordance with the terms of such agreement, including terms

providing for reimbursement from funds available for that military department.

(b) MODIFICATION OR TERMINATION.—Any agreement described

in subsection (a) shall remain in effect in accordance with such

subsection unless, during the 12-month period following the date of

the enactment of this Act, such agreement is modified or terminated in accordance with the terms of such agreement.

SEC. 742. ø10 U.S.C. 1071 note¿ PROCESSES FOR PATIENT SAFETY IN

MILITARY AND VETERANS HEALTH CARE SYSTEMS.

(a) ERROR TRACKING PROCESS.—The Secretary of Defense shall

implement a centralized process for reporting, compilation, and

analysis of errors in the provision of health care under the defense

health program that endanger patients beyond the normal risks associated with the care and treatment of such patients. To the extent practicable, that process shall emulate the system established

by the Secretary of Veterans Affairs for reporting, compilation, and

analysis of errors in the provision of health care under the Department of Veterans Affairs health care system that endanger patients

beyond such risks.

(b) SHARING OF INFORMATION.—The Secretary of Defense and

the Secretary of Veterans Affairs—

(1) shall share information regarding the designs of systems or protocols established to reduce errors in the provision

of health care described in subsection (a); and

(2) shall develop such protocols as the Secretaries consider

necessary for the establishment and administration of effective

processes for the reporting, compilation, and analysis of such

errors.

SEC. 743. ø10 U.S.C. 1071 note¿ COOPERATION IN DEVELOPING PHARMACEUTICAL IDENTIFICATION TECHNOLOGY.

The Secretary of Defense and the Secretary of Veterans Affairs

shall cooperate in developing systems for the use of bar codes for

the identification of pharmaceuticals in the health care programs

of the Department of Defense and the Department of Veterans Affairs. In any case in which a common pharmaceutical is used in

such programs, the bar codes for those pharmaceuticals shall, to

the maximum extent practicable, be identical.

Subtitle F—Other Matters

* * * * * * *

SEC. 754. ø10 U.S.C. 1071 note¿ PATIENT CARE REPORTING AND MANAGEMENT SYSTEM.

(a) ESTABLISHMENT.—The Secretary of Defense shall establish

a patient care error reporting and management system.
121 Sec. 754 P.L. 106–398 (DEFENSE AUTHORIZATION, FY01)

(b) PURPOSES OF SYSTEM.—The purposes of the system are as

follows:

(1) To study the occurrences of errors in the patient care

provided under chapter 55 of title 10, United States Code.

(2) To identify the systemic factors that are associated

with such occurrences.

(3) To provide for action to be taken to correct the identified systemic factors.

(c) REQUIREMENTS FOR SYSTEM.—The patient care error reporting and management system shall include the following:

(1) A hospital-level patient safety center, within the quality assurance department of each health care organization of

the Department of Defense, to collect, assess, and report on the

nature and frequency of errors related to patient care.

(2) For each health care organization of the Department of

Defense and for the entire Defense health program, patient

safety standards that are necessary for the development of a

full understanding of patient safety issues in each such organization and the entire program, including the nature and types

of errors and the systemic causes of the errors.

(3) Establishment of a Department of Defense Patient

Safety Center within the Armed Forces Institute of Pathology,

which shall have the following missions:

(A) To analyze information on patient care errors that

is submitted to the Center by each military health care organization.

(B) To develop action plans for addressing patterns of

patient care errors.

(C) To execute those action plans to mitigate and control errors in patient care with a goal of ensuring that the

health care organizations of the Department of Defense

provide highly reliable patient care with virtually no error.

(D) To provide, through the Assistant Secretary of Defense for Health Affairs, to the Agency for Healthcare Research and Quality of the Department of Health and

Human Services any reports that the Assistant Secretary

determines appropriate.

(E) To review and integrate processes for reducing errors associated with patient care and for enhancing patient

safety.

(F) To contract with a qualified and objective external

organization to manage the national patient safety database of the Department of Defense.

(d) MEDTEAMS PROGRAM.—The Secretary shall expand the

health care team coordination program to integrate that program

into all Department of Defense health care operations. In carrying

out this subsection, the Secretary shall take the following actions:

(1) Establish not less than two Centers of Excellence for

the development, validation, proliferation, and sustainment of

the health care team coordination program, one of which shall

support all fixed military health care organizations, the other

of which shall support all combat casualty care organizations.
Sec. 754 P.L. 106–398 (DEFENSE AUTHORIZATION, FY01) 122

(2) Deploy the program to all fixed and combat casualty

care organizations of each of the Armed Forces, at the rate of

not less than 10 organizations in each fiscal year.

(3) Expand the scope of the health care team coordination

program from a focus on emergency department care to a coverage that includes care in all major medical specialties, at the

rate of not less than one specialty in each fiscal year.

(4) Continue research and development investments to improve communication, coordination, and team work in the provision of health care.

(e) CONSULTATION.—The Secretary shall consult with the other

administering Secretaries (as defined in section 1072(3) of title 10,

United States Code) in carrying out this section.
123

NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEAR 2000

(P.L. 106–65, approved Oct. 5, 1999)

DIVISION A—DEPARTMENT OF

DEFENSE AUTHORIZATIONS

* * * * * * *

TITLE VII—HEALTH CARE PROVISIONS

* * * * * * *

Subtitle A—Health Care Services

* * * * * * *

SEC. 703. ø10 U.S.C. 1077 note¿ PROVISION OF DOMICILIARY AND CUSTODIAL CARE FOR CERTAIN CHAMPUS BENEFICIARIES.

øRepealed by section 701(g)(1)(A) the National Defense Authorization Act for Fiscal Year 2002 (P.L. 107–107; 115 Stat. 1161)¿

* * * * * * *

SEC. 706. ø10 U.S.C. 1074 note¿ HEALTH CARE AT FORMER UNIFORMED

SERVICES TREATMENT FACILITIES FOR ACTIVE DUTY

MEMBERS STATIONED AT CERTAIN REMOTE LOCATIONS.

(a) AUTHORITY.—Health care may be furnished by a designated

provider pursuant to any contract entered into by the designated

provider under section 722(b) of the National Defense Authorization Act for Fiscal Year 1997 (Public Law 104–201; 10 U.S.C. 1073

note) to eligible members who reside within the service area of the

designated provider.

(b) ELIGIBILITY.—A member of the uniformed services (as defined in section 1072(1) of title 10, United States Code) is eligible

for health care under subsection (a) if the member is a member described in section 731(c) of the National Defense Authorization Act

for Fiscal Year 1998 (Public Law 105–85; 111 Stat. 1811; 10 U.S.C.

1074 note).

(c) APPLICABLE POLICIES.—In furnishing health care to an eligible member under subsection (a), a designated provider shall adhere to the Department of Defense policies applicable to the furnishing of care under the TRICARE Prime Remote program, including coordinating with uniformed services medical authorities

for hospitalizations and all referrals for specialty care.

(d) REIMBURSEMENT RATES.—The Secretary of Defense, in consultation with the designated providers, shall prescribe reimbursement rates for care furnished to eligible members under subsection

(a). The rates prescribed for health care may not exceed the
Sec. 723 P.L. 106–65 (DEFENSE AUTHORIZATION, FY00) 124

amounts allowable under the TRICARE Standard plan for the

same care.

* * * * * * *

Subtitle C—Other Matters

* * * * * * *

SEC. 723. ø10 U.S.C. 1071 note¿ HEALTH CARE QUALITY INFORMATION

AND TECHNOLOGY ENHANCEMENT.

(a) PURPOSE.—The purpose of this section is to ensure that the

Department of Defense addresses issues of medical quality surveillance and implements solutions for those issues in a timely manner

that is consistent with national policy and industry standards.

(b) DEPARTMENT OF DEFENSE PROGRAM FOR MEDICAL

INFORMATICS AND DATA.—The Secretary of Defense shall establish

a Department of Defense program, the purposes of which shall be

the following:

(1) To develop parameters for assessing the quality of

health care information.

(2) To develop the defense digital patient record.

(3) To develop a repository for data on quality of health

care.

(4) To develop capability for conducting research on quality

of health care.

(5) To conduct research on matters of quality of health

care.

(6) To develop decision support tools for health care providers.

(7) To refine medical performance report cards.

(8) To conduct educational programs on medical

informatics to meet identified needs.

(c) AUTOMATION AND CAPTURE OF CLINICAL DATA.—(1) Through

the program established under subsection (b), the Secretary of Defense shall accelerate the efforts of the Department of Defense to

automate, capture, and exchange controlled clinical data and

present providers with clinical guidance using a personal information carrier, clinical lexicon, or digital patient record.

(2) The program shall serve as a primary resource for the Department of Defense for matters concerning the capture, processing, and dissemination of data on health care quality.

(d) MEDICAL INFORMATICS ADVISORY COMMITTEE.—(1) The Secretary of Defense shall establish a Medical Informatics Advisory

Committee (hereinafter referred to as the ‘‘Committee’’), the members of which shall be the following:

(A) The Assistant Secretary of Defense for Health Affairs.

(B) The Director of the TRICARE Management Activity of

the Department of Defense.

(C) The Surgeon General of the Army.

(D) The Surgeon General of the Navy.

(E) The Surgeon General of the Air Force.

(F) Representatives of the Department of Veterans Affairs,

designated by the Secretary of Veterans Affairs.
125 Sec. 723 P.L. 106–65 (DEFENSE AUTHORIZATION, FY00)

(G) Representatives of the Department of Health and

Human Services, designated by the Secretary of Health and

Human Services.

(H) Any additional members appointed by the Secretary of

Defense to represent health care insurers and managed care

organizations, academic health institutions, health care providers (including representatives of physicians and representatives of hospitals), and accreditors of health care plans and organizations.

(2) The primary mission of the Committee shall be to advise

the Secretary on the development, deployment, and maintenance of

health care informatics systems that allow for the collection, exchange, and processing of health care quality information for the

Department of Defense in coordination with other Federal departments and agencies and with the private sector.

(3) Specific areas of responsibility of the Committee shall include advising the Secretary on the following:

(A) The ability of the medical informatics systems at the

Department of Defense and Department of Veterans Affairs to

monitor, evaluate, and improve the quality of care provided to

beneficiaries.

(B) The coordination of key components of medical

informatics systems, including digital patient records, both

within the Federal Government and between the Federal Government and the private sector.

(C) The development of operational capabilities for executive information systems and clinical decision support systems

within the Department of Defense and Department of Veterans

Affairs.

(D) Standardization of processes used to collect, evaluate,

and disseminate health care quality information.

(E) Refinement of methodologies by which the quality of

health care provided within the Department of Defense and

Department of Veterans Affairs is evaluated.

(F) Protecting the confidentiality of personal health information.

(4) The Assistant Secretary of Defense for Health Affairs shall

consult with the Committee on the issues described in paragraph

(3).

(5) The Secretary of Defense shall submit to Congress an annual report on medical informatics. The report shall include a discussion of the following matters:

(A) The activities of the Committee.

(B) The coordination of development, deployment, and

maintenance of health care informatics systems within the

Federal Government, and between the Federal Government

and the private sector.

(C) The progress or growth occurring in medical

informatics.

(D) How the TRICARE program and the Department of

Veterans Affairs health care system can use the advancement

of knowledge in medical informatics to raise the standards of

health care and treatment and the expectations for improving

health care and treatment.
Sec. 724 P.L. 106–65 (DEFENSE AUTHORIZATION, FY00) 126

(6) Members of the Committee shall not be paid by reason of

their service on the Committee.

(7) The Federal Advisory Committee Act (5 U.S.C. App.) shall

not apply to the Committee.

(e) ANNUAL REPORT.—The Assistant Secretary of Defense for

Health Affairs shall submit to Congress on an annual basis a report on the quality of health care furnished under the health care

programs of the Department of Defense. The report shall cover the

most recent fiscal year ending before the date the report is submitted and shall contain a discussion of the quality of the health

care measured on the basis of each statistical and customer satisfaction factor that the Assistant Secretary determines appropriate,

including, at a minimum, a discussion of the following:

(1) Health outcomes.

(2) The extent of use of health report cards.

(3) The extent of use of standard clinical pathways.

(4) The extent of use of innovative processes for surveillance.

SEC. 724. ø10 U.S.C. 1092 note¿ JOINT TELEMEDICINE AND TELEPHARMACY DEMONSTRATION PROJECTS BY THE DEPARTMENT

OF DEFENSE AND DEPARTMENT OF VETERANS AFFAIRS.

(a) IN GENERAL.—The Secretary of Defense and the Secretary

of Veterans Affairs may carry out joint demonstration projects for

purposes of evaluating the feasibility and practicability of using

telecommunications to provide health care services and pharmacy

services.

(b) SERVICES TO BE PROVIDED.—The services provided under

the demonstration projects may include the following:

(1) Radiology and imaging services.

(2) Diagnostic services.

(3) Referral services.

(4) Clinical pharmacy services.

(5) Any other health care services or pharmacy services

designated by the Secretaries.

(c) SELECTION OF LOCATIONS.—(1) The Secretaries may carry

out the demonstration projects described in subsection (a) at not

more than five locations selected by the Secretaries from locations

in which are located both a uniformed services treatment facility

and a Department of Veterans Affairs medical center that are affiliated with academic institutions having a demonstrated expertise

in the provision of health care services or pharmacy services by

means of telecommunications.

(2) Representatives of a facility and medical center selected

under paragraph (1) shall, to the maximum extent practicable,

carry out the demonstration project in consultation with representatives of the academic institution or institutions with which affiliated.

(d) PERIOD OF DEMONSTRATION PROJECTS.—The Secretaries

may carry out the demonstration projects during the three-year period beginning on October 1, 1999.

(e) REPORT.—øRepealed by section 1031(h) of P.L. 108–136¿
127

STROM THURMOND NATIONAL DEFENSE AUTHORIZATION ACT FOR

FISCAL YEAR 1999

(P.L. 105–261, approved Oct. 17, 1998)

DIVISION A—DEPARTMENT OF

DEFENSE AUTHORIZATIONS

* * * * * * *

TITLE VII—HEALTH CARE PROVISIONS

* * * * * * *

Subtitle C—Health Care Services for Medicare-Eligible

Department of Defense Beneficiaries

* * * * * * *

SEC. 722. ø10 U.S.C. 1073 note¿ TRICARE AS SUPPLEMENT TO MEDICARE

DEMONSTRATION.

(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, 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
Sec. 722 P.L. 105–261 (DEFENSE AUTHORIZATION, FY99) 128

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 89 of title 5, 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 Com-
129 Sec. 722 P.L. 105–261 (DEFENSE AUTHORIZATION, FY99)

mittee 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 1074(b) of

title 10, 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 (42 U.S.C. 1395c et

seq.);

(3) is enrolled in the supplemental medical insurance program under part B of such title XVIII (42 U.S.C. 1395j 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 (42 U.S.C.

1395mm) and no Medicare+Choice organization has a contract in effect under part C of title XVIII of that Act (42

U.S.C. 1395w–21); 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:
Sec. 723 P.L. 105–261 (DEFENSE AUTHORIZATION, FY99) 130

(1) The term ‘‘administering Secretaries’’ has the meaning

given that term in section 1072(3) of title 10, United States

Code.

(2) The term ‘‘TRICARE program’’ has the meaning given

that term in section 1072(7) of title 10, United States Code.

SEC. 723. ø10 U.S.C. 1073 note¿ IMPLEMENTATION OF REDESIGN OF

PHARMACY SYSTEM.

(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 703.

(b) PROGRAM REQUIREMENTS.—The same coverage for pharmacy services and the same requirements for cost sharing and reimbursement as are applicable under section 1086 of title 10,

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 1074(b) of

title 10, 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;
131 Sec. 745 P.L. 105–261 (DEFENSE AUTHORIZATION, FY99)

(B) is entitled to hospital insurance benefits under part A

of title XVIII of the Social Security Act (42 U.S.C. 1395c 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 (42 U.S.C. 1395j 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.

SEC. 724. ø10 U.S.C. 1108 note¿ COMPREHENSIVE EVALUATION OF IMPLEMENTATION OF DEMONSTRATION PROJECTS AND

TRICARE PHARMACY REDESIGN.

Not later than March 31, 2003, the Comptroller General shall

submit to the Committee on Armed Services of the Senate and the

Committee on National Security of the House of Representatives a

report containing a comprehensive comparative analysis of the

FEHBP demonstration project conducted under section 1108 of title

10, United States Code (as added by section 721), the TRICARE

Senior Supplement under section 722, and the redesign of the

TRICARE pharmacy system under section 723. The comprehensive

analysis shall incorporate the findings of the evaluation submitted

under section 723(c) and the report submitted under subsection ( j)

of such section 1108.

* * * * * * *

SEC. 745. ø10 U.S.C. 1071 note¿ JOINT DEPARTMENT OF DEFENSE AND

DEPARTMENT OF VETERANS AFFAIRS REPORTS RELATING TO INTERDEPARTMENTAL COOPERATION IN THE DELIVERY OF MEDICAL CARE.

(a) FINDINGS.—Congress makes the following findings:

(1) The military health care system of the Department of

Defense and the Veterans Health Administration of the Department of Veterans Affairs are national institutions that collectively manage more than 1,500 hospitals, clinics, and health

care facilities worldwide to provide services to more than

11,000,000 beneficiaries.

(2) In the post-Cold War era, these institutions are in a

profound transition that involves challenging opportunities.

(3) During the period from 1988 to 1998, the number of

military medical personnel has declined by 15 percent and the

number of military hospitals has been reduced by one-third.

(4) During the 2 years since 1996, the Department of Veterans Affairs has revitalized its structure by decentralizing authority into 22 Veterans Integrated Service Networks.

(5) In the face of increasing costs of medical care, increased demands for health care services, and increasing budgetary constraints, the Department of Defense and the Department of Veterans Affairs have embarked on a variety of dynamic and innovative cooperative programs ranging from

shared services to joint venture operations of medical facilities.

(6) In 1984, there was a combined total of 102 Department

of Veterans Affairs and Department of Defense facilities with

sharing agreements. By 1997, that number had grown to 420.

During the six years from fiscal year 1992 through fiscal year

1997, shared services increased from slightly over 3,000 serv-
Sec. 745 P.L. 105–261 (DEFENSE AUTHORIZATION, FY99) 132

ices to more than 6,000 services, ranging from major medical

and surgical services, laundry, blood, and laboratory services to

unusual speciality care services.

(7) The Department of Defense and the Department of Veterans Affairs are conducting four health care joint ventures in

New Mexico, Nevada, Texas, and Oklahoma, and are planning

to conduct four more such ventures in Alaska, Florida, Hawaii,

and California.

(b) SENSE OF CONGRESS.—It is the sense of Congress that—

(1) the Department of Defense and the Department of Veterans Affairs should be commended for the cooperation between the two departments in the delivery of medical care, of

which the cooperation involved in the establishment and operation of the Department of Defense and the Department of Veterans Affairs Executive Council is a praiseworthy example;

(2) the Department of Defense and the Department of Veterans Affairs are encouraged to continue to explore new opportunities to enhance the availability and delivery of medical

care to beneficiaries by further enhancing the cooperative efforts of the departments; and

(3) enhanced cooperation between the Department of Defense and the Department of Veterans Affairs is encouraged

regarding—

(A) the general areas of access to quality medical care,

identification and elimination of impediments to enhanced

cooperation, and joint research and program development;

and

(B) the specific areas in which there is significant potential to achieve progress in cooperation in a short term,

including computerization of patient records systems, participation of the Department of Veterans Affairs in the

TRICARE program, pharmaceutical programs, and joint

physical examinations.

(c) JOINT SURVEY OF POPULATIONS SERVED.—(1) The Secretary

of Defense and the Secretary of Veterans Affairs shall jointly conduct a survey of their respective medical care beneficiary populations to identify, by category of beneficiary (defined as the Secretaries consider appropriate), the expectations of, requirements for,

and behavior patterns of the beneficiaries with respect to medical

care. The two Secretaries shall develop the protocol for the survey

jointly, but shall obtain the services of an entity independent of the

Department of Defense and the Department of Veterans Affairs to

carry out the survey.

(2) The survey shall include the following:

(A) Demographic characteristics, economic characteristics,

and geographic location of beneficiary populations with regard

to catchment or service areas.

(B) The types and frequency of care required by veterans,

retirees, and dependents within catchment or service areas of

Department of Defense and Department of Veterans Affairs

medical facilities and outside those areas.

(C) The numbers of, characteristics of, and types of medical care needed by the veterans, retirees, and dependents who,

though eligible for medical care in Department of Defense or
133 Sec. 745 P.L. 105–261 (DEFENSE AUTHORIZATION, FY99)

Department of Veterans Affairs treatment facilities or through

other federally funded medical programs, choose not to seek

medical care from those facilities or under those programs, and

the reasons for that choice.

(D) The obstacles or disincentives for seeking medical care

from such facilities or under such programs that are perceived

by veterans, retirees, and dependents.

(E) Any other matters that the Secretary of Defense and

the Secretary of Veterans Affairs consider appropriate for the

survey.

(3) The Secretary of Defense or the Secretary of Veterans Affairs may waive the survey requirements under this subsection

with respect to information that can be better obtained from a

source other than the survey.

(4) The Secretary of Defense and the Secretary of Veterans Affairs shall submit a report on the results of the survey to the appropriate committees of Congress. The report shall contain the

matters described in paragraph (2) and any proposals for legislation that the Secretaries recommend for enhancing Department of

Defense and Department of Veterans Affairs cooperative efforts

with respect to the delivery of medical care.

(d) REVIEW OF LAW AND POLICIES.—(1) The Secretary of Defense and the Secretary of Veterans Affairs shall jointly conduct a

review to identify impediments to cooperation between the Department of Defense and the Department of Veterans Affairs regarding

the delivery of medical care. The matters reviewed shall include

the following:

(A) All laws, policies, and regulations, and any attitudes of

beneficiaries of the health care systems of the two departments, that have the effect of preventing the establishment, or

limiting the effectiveness, of cooperative health care programs

of the departments.

(B) The requirements and practices involved in the

credentialling and licensure of health care providers.

(C) The perceptions of beneficiaries in a variety of categories (defined as the Secretaries consider appropriate) regarding the various Federal health care systems available for

their use.

(D) The types and frequency of medical services furnished

by the Department of Defense and the Department of Veterans

Affairs through cooperative arrangements to each category of

beneficiary (including active-duty members, retirees, dependents, veterans in the health-care eligibility categories referred

to as Category A and Category C, and persons authorized to

receive medical care under section 1713 of title 38, United

States Code) of the other department.

(E) The extent to which health care facilities of the Department of Defense and Department of Veterans Affairs have

sufficient capacity, or could jointly or individually create sufficient capacity, to provide services to beneficiaries of the other

department without diminution of access or services to their

primary beneficiaries.

(F) The extent to which the recruitment of scarce medical

specialists and allied health personnel by the Department of
Sec. 745 P.L. 105–261 (DEFENSE AUTHORIZATION, FY99) 134

Defense and the Department of Veterans Affairs could be enhanced through cooperative arrangements for providing health

care services.

(G) The obstacles and disincentives to providing health

care services through cooperative arrangements between the

Department of Defense and the Department of Veterans Affairs.

(2) The Secretaries shall jointly submit a report on the results

of the review to the appropriate committees of Congress. The report

shall include any proposals for legislation that the Secretaries recommend for eliminating or reducing impediments to interdepartmental cooperation that are identified during the review.

(e) PARTICIPATION IN TRICARE.—The Secretary of Defense

shall review the TRICARE program to identify opportunities for increased participation by the Department of Veterans Affairs in that

program. The ongoing collaboration between Department of Defense officials and Department of Veterans Affairs officials regarding increased participation shall be included among the matters reviewed.

(f ) PHARMACEUTICAL BENEFITS AND PROGRAMS.—(1) The Department of Defense-Department of Veterans Affairs Federal Pharmacy Executive Steering Committee shall—

(A) undertake a comprehensive examination of existing

pharmaceutical benefits and programs for beneficiaries of Department of Defense medical care programs, including matters

relating to the purchasing, distribution, and dispensing of

pharmaceuticals and the management of mail order pharmaceuticals programs; and

(B) review the existing methods for contracting for and distributing medical supplies and services.

(2) The committee shall submit a report on the results of the

examination to the appropriate committees of Congress.

(g) STANDARDIZATION OF PHYSICAL EXAMINATIONS FOR DISABILITY.—The Secretary of Defense and the Secretary of Veterans

Affairs shall jointly submit to the appropriate committees of Congress a report on the status of the efforts of the Department of Defense and the Department of Veterans Affairs to standardize physical examinations administered by the two departments for the

purpose of determining or rating disabilities.

(h) APPROPRIATE COMMITTEES OF CONGRESS DEFINED.—For the

purposes of this section, the appropriate committees of Congress

are as follows:

(1) The Committee on Armed Services and the Committee

on Veterans’ Affairs of the Senate.

(2) The Committee on Armed Services and the Committee

on Veterans’ Affairs of the House of Representatives.

(i) DEADLINES FOR SUBMISSION OF REPORTS.—(1) The report required by subsection (c)(3) shall be submitted not later than January 1, 2000.

(2) The report required by subsection (d)(2) shall be submitted

not later than March 1, 1999.

(3) The semiannual report required by subsection (e)(2) shall

be submitted not later than March 1 and September 1 of each year.
135 Sec. 745 P.L. 105–261 (DEFENSE AUTHORIZATION, FY99)

(4) The report on the examination required under subsection

(f ) shall be submitted not later than 60 days after the completion

of the examination.

(5) The report required by subsection (g) shall be submitted not

later than March 1, 1999.
136

1Subsection (a)(2) of section 722 of the Floyd D. Spence National Defense Authorization Act

for Fiscal Year 2001 (as enacted by Public Law 106–398; October 30, 2000; 114 Stat. 1654A–

185) amended subsections (b), (c), and (d)(3) of section 731 by striking ‘‘Armed Forces’’ and inserting ‘‘uniformed services’’. It also added a new paragraph (4) at the end of subsection (b) and

a new paragraph (3) at the end of subsection (f). Subsection (b)(2) of such section 722 added

the second sentence to subsection (b)(1) and made a conforming change in subsection (b)(2).

However, subsection (c)(2) of such section 722 provides as follows:

(2) The amendments made by subsection (a)(2), with respect to members of the uniformed

services, and the amendments made by subsection (b)(2), with respect to dependents of members, shall take effect on the date of the enactment of this Act and shall expire with respect

to a member or the dependents of a member, respectively, on the later of the following:

(A) The date that is one year after the date of the enactment of this Act.

(B) The date on which the policies required by the amendments made by subsection (a)(1)

or (b)(1) are implemented with respect to the coverage of medical care for and provision of

such care to the member or dependents, respectively.

NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEAR 1998

(P.L. 105–85, approved Nov. 18, 1997)

DIVISION A—DEPARTMENT OF

DEFENSE AUTHORIZATIONS

* * * * * * *

TITLE VII—HEALTH CARE PROVISIONS

* * * * * * *

SEC. 731. ø10 U.S.C. 1074 note¿ IMPROVEMENTS IN HEALTH CARE COVERAGE AND ACCESS FOR MEMBERS ASSIGNED TO CERTAIN DUTY LOCATIONS FAR FROM SOURCES OF CARE.

(a) [Omitted-Amendment]

(b) TEMPORARY AUTHORITY FOR MANAGED CARE EXPANSION TO

MEMBERS ON ACTIVE DUTY AT CERTAIN REMOTE LOCATIONS.—(1) A

member of the uniformed services 1 described in subsection (c) is

entitled to receive care under the Civilian Health and Medical Program of the Uniformed Services. In connection with such care, the

Secretary of Defense shall waive the obligation of the member to

pay a deductible, copayment, or annual fee that would otherwise be

applicable under that program for care provided to the members

under the program. A dependent of the member, as described in

subparagraph (A), (D), or (I) of section 1072(2) of title 10, United

States Code, who is residing with the member shall have the same

entitlement to care and to waiver of charges as the member.

(2) A member or dependent of the member, as the case may be,

who is entitled under paragraph (1) to receive health care services

under CHAMPUS shall receive such care from a network provider

under the TRICARE program if such a provider is available in the

service area of the member.
137 Sec. 731 P.L. 105–85 (DEFENSE AUTHORIZATION, FY98)

2Subsection (c)(3) of section 722 of the Floyd D. Spence National Defense Authorization Act

for Fiscal Year 2001 (as enacted by Public Law 106–398; 114 Stat. 1654A–186) provides that

subsection (b)(3) does not apply with respect to ‘‘a member of the Coast Guard, the National

Oceanic and Atmospheric Administration, or the Commissioned Corps of the Public Health Service, or to a dependent of a member of a uniformed service’’.

(3) Paragraph (1) shall take effect on the date of the enactment

of this Act and shall expire with respect to a member upon the

later of the following: 2

(A) The date that is one year after the date of the enactment of this Act.

(B) The date on which the amendments made by subsection (a) apply with respect to the coverage of medical care

for, and provision of such care to, the member.

(4) The Secretary of Defense shall consult with the other administering Secretaries in the administration of this subsection.

(c) ELIGIBLE MEMBERS.—A member referred to in subsection

(b) is a member of the uniformed services on active duty who—

(1) receives a duty assignment described in subsection (d);

and

(2) pursuant to the assignment of such duty, resides at a

location that is more than 50 miles, or approximately one hour

of driving time, from—

(A) the nearest health care facility of the uniformed

services adequate to provide the needed care under chapter 55 of title 10, United States Code; and

(B) the nearest source of the needed care that is available to the member under the TRICARE Prime plan.

(d) DUTY ASSIGNMENTS COVERED.—A duty assignment referred

to in subsection (c)(1) means any of the following:

(1) Permanent duty as a recruiter.

(2) Permanent duty at an educational institution to instruct, administer a program of instruction, or provide administrative services in support of a program of instruction for the

Reserve Officers’ Training Corps.

(3) Permanent duty as a full-time adviser to a unit of a reserve component of the uniformed services.

(4) Any other permanent duty designated by the Secretary

concerned for purposes of this subsection.

(e) PAYMENT OF COSTS.—Deductibles, copayments, and annual

fees not payable by a member by reason of a waiver granted under

the regulations prescribed pursuant to subsection (b) shall be paid

out of funds available to the Department of Defense for the Defense

Health Program.

(f) DEFINITIONS.—In this section:

(1) The term ‘‘TRICARE program’’ has the meaning given

that term in section 1072(7) of title 10, United States Code.

(2) The term ‘‘TRICARE Prime plan’’ means a plan under

the TRICARE program that provides for the voluntary enrollment of persons for the receipt of health care services to be furnished in a manner similar to the manner in which health care

services are furnished by health maintenance organizations.
Sec. 743 P.L. 105–85 (DEFENSE AUTHORIZATION, FY98) 138

(3) The terms ‘‘uniformed services’’ and ‘‘administering

Secretaries’’ have the meanings given those terms in section

1072 of title 10, United States Code.

* * * * * * *

SEC. 743. AUTHORITY FOR AGREEMENT FOR USE OF MEDICAL RESOURCE FACILITY, ALAMOGORDO, NEW MEXICO.

(a) AUTHORITY.—(1) The Secretary of the Air Force may enter

into an agreement with Gerald Champion Hospital, Alamogordo,

New Mexico, under which the Secretary may furnish health care

services to eligible individuals in a medical resource facility in

Alamogordo, New Mexico, that is constructed and equipped, in

part, using funds provided by the Secretary under the agreement.

(2) For purposes of this section:

(A) The term ‘‘eligible individual’’ means any individual eligible for medical and dental care under chapter 55 of title 10,

United States Code, including any member of the uniformed

services entitled to such care under section 1074(a) of that

title.

(B) The terms ‘‘medical resource facility’’ and ‘‘facility’’

mean the medical resource facility to be constructed and

equipped pursuant to the agreement authorized by paragraph

(1).

(C) The term ‘‘Hospital’’ means Gerald Champion Hospital,

Alamogordo, New Mexico.

(b) CONTENT OF AGREEMENT.—Any agreement entered into

under subsection (a) shall specify, at a minimum, the following:

(1) The relationship between the Hospital and the Secretary of the Air Force in the provision of health care services

to eligible individuals in the medical resource facility,

including—

(A) whether or not the Secretary and the Hospital are

to use and administer the facility jointly or independently;

and

(B) under what circumstances the Hospital is to act as

a provider of health care services under the managed care

option of the TRICARE program known as TRICARE

Prime.

(2) Matters relating to the administration of the agreement, including—

(A) the duration of the agreement;

(B) the rights and obligations of the Secretary and the

Hospital under the agreement, including any contracting

or grievance procedures applicable under the agreement;

(C) the types of care to be provided to eligible individuals under the agreement, including the cost to the Department of the Air Force of providing the care to eligible

individuals during the term of the agreement;

(D) the access of Air Force medical personnel to the facility under the agreement;

(E) the rights and responsibilities of the Secretary and

the Hospital upon termination of the agreement; and

(F) any other matters jointly identified by the Secretary and the Hospital.
139 Sec. 743 P.L. 105–85 (DEFENSE AUTHORIZATION, FY98)

(3) The nature of the arrangement between the Secretary

and the Hospital with respect to the ownership of the facility

and any property under the agreement, including—

(A) the nature of that arrangement while the agreement is in force;

(B) the nature of that arrangement upon termination

of the agreement; and

(C) any requirement for reimbursement of the Secretary by the Hospital as a result of the arrangement upon

termination of the agreement.

(4) The amount of the funds made available under subsection (c) that the Secretary will contribute for the construction and equipping of the facility.

(5) Any conditions or restrictions relating to the construction, equipping, or use of the facility.

(c) AVAILABILITY OF FUNDS FOR CONSTRUCTION AND EQUIPPING

OF FACILITY.—(1) Of the amount authorized to be appropriated pursuant to section 301(4) for operation and maintenance for the Air

Force, not more than $7,000,000 may be used by the Secretary of

the Air Force to make a contribution toward the construction and

equipping of the medical resource facility in the event that the Secretary enters into the agreement authorized by subsection (a). Notwithstanding any other provision of law, the Secretary may not use

other sources of funds to make a contribution toward the construction or equipping of the facility.

(2) Notwithstanding subsection (b)(3) regarding the ownership

and reimbursement issues to be addressed in the agreement authorized by subsection (a), the Secretary may not contribute funds

made available under paragraph (1) toward the construction and

equipping of the facility unless the agreement requires, in exchange for the contribution, that the Hospital provide health care

services to eligible individuals without charge to the Secretary or

at a reduced rate. The value of the services provided by the Hospital shall be at least equal to the amount of the contribution made

by the Secretary, and the Hospital shall complete the provision of

services equal in value to the Secretary’s contribution within seven

years after the facility becomes operational. The provision of additional discounted services to be provided by the Hospital shall be

included in the agreement. The value and types of services to be

provided by the Hospital shall be negotiated in accordance with

principles of resource-sharing agreements under the TRICARE program.

(d) NOTICE AND WAIT.—The Secretary of the Air Force may not

enter into the agreement authorized by subsection (a) until 90 days

after the Secretary of Defense submits to the congressional defense

committees the report required by subsection (e).

(e) REPORT ON PROPOSED AGREEMENT.—The Secretary of Defense shall submit to Congress a report containing an analysis of,

and recommendations regarding, the agreement proposed to be entered into under subsection (a), in particular, the implications of

the agreement on regional health care costs and its effect on implementation of the TRICARE program in the region. The report shall

also include a copy of the agreement, the results of a cost-benefit

analysis conducted by the Secretary of the Air Force with respect
Sec. 744 P.L. 105–85 (DEFENSE AUTHORIZATION, FY98) 140

to the agreement, and such other information with respect to the

agreement as the Secretary of Defense and the Secretary of the Air

Force considers appropriate. The cost-benefit analysis shall consider the effects of the agreement on operation and maintenance

and military construction requirements at Holloman Air Force

Base, New Mexico.

(f) SUBSEQUENT REPORTS.—If the Secretary of the Air Force enters into the agreement authorized by subsection (a), the Secretary

shall submit to Congress an annual report containing a revised

cost-benefit analysis of the consequences of the agreement as in effect during the year covered by the report, including a full accounting of any cost savings realized by the Department of the Air Force

as a result of the agreement. A report shall be submitted for each

year in which the agreement is in effect or until the Hospital provides the full value of health care services required under subsection (c)(2), whichever occurs first.

SEC. 744. ø10 U.S.C. 1073 note¿ DISCLOSURES OF CAUTIONARY INFORMATION ON PRESCRIPTION MEDICATIONS.

(a) REGULATIONS REQUIRED.—Not later than 180 days after the

date of the enactment of this Act, the Secretary of Defense, in consultation with the administering Secretaries referred to in section

1073 of title 10, 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 55 of title 10, 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; 110 Stat. 2593; 10 U.S.C. 1073 note).

SEC. 745. ø10 U.S.C. 1073 note¿ COMPETITIVE PROCUREMENT OF CERTAIN OPHTHALMIC SERVICES.

(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
141 Sec. 1078 P.L. 105–85 (DEFENSE AUTHORIZATION, FY98)

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 55 of title 10, 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.

* * * * * * *

TITLE X—GENERAL PROVISIONS

* * * * * * *

SEC. 1078. ø50 U.S.C. 1520a¿ RESTRICTIONS ON THE USE OF HUMAN

SUBJECTS FOR TESTING OF CHEMICAL OR BIOLOGICAL

AGENTS.

(a) PROHIBITED ACTIVITIES.—The Secretary of Defense may not

conduct (directly or by contract)—

(1) any test or experiment involving the use of a chemical

agent or biological agent on a civilian population; or

(2) any other testing of a chemical agent or biological

agent on human subjects.

(b) EXCEPTIONS.—Subject to subsections (c), (d), and (e), the

prohibition in subsection (a) does not apply to a test or experiment

carried out for any of the following purposes:

(1) Any peaceful purpose that is related to a medical,

therapeutic, pharmaceutical, agricultural, industrial, or research activity.

(2) Any purpose that is directly related to protection

against toxic chemicals or biological weapons and agents.

(3) Any law enforcement purpose, including any purpose

related to riot control.

(c) INFORMED CONSENT REQUIRED.—The Secretary of Defense

may conduct a test or experiment described in subsection (b) only

if informed consent to the testing was obtained from each human

subject in advance of the testing on that subject.

(d) PRIOR NOTICE TO CONGRESS.—Not later than 30 days after

the date of final approval within the Department of Defense of

plans for any experiment or study to be conducted by the Department of Defense (whether directly or under contract) involving the

use of human subjects for the testing of a chemical agent or a biological agent, the Secretary of Defense shall submit to the Committee on Armed Services of the Senate and the Committee on

Armed Services of the House of Representatives a report setting

forth a full accounting of those plans, and the experiment or study
Sec. 1078 P.L. 105–85 (DEFENSE AUTHORIZATION, FY98) 142

may then be conducted only after the end of the 30-day period beginning on the date such report is received by those committees.

(e) BIOLOGICAL AGENT DEFINED.—In this section, the term ‘‘biological agent’’ means any micro-organism (including bacteria, viruses, fungi, rickettsiac, or protozoa), pathogen, or infectious substance, and any naturally occurring, bioengineered, or synthesized

component of any such micro-organism, pathogen, or infectious substance, whatever its origin or method of production, that is capable

of causing—

(1) death, disease, or other biological malfunction in a

human, an animal, a plant, or another living organism;

(2) deterioration of food, water, equipment, supplies, or

materials of any kind; or

(3) deleterious alteration of the environment.

(f) REPORT AND CERTIFICATION.—[Omitted-Amendment]

(g) REPEAL OF SUPERSEDED PROVISION OF LAW.—[OmittedAmendment]
143

NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEAR 1997

(P.L. 104–201, approved Sept. 23, 1996)

DIVISION A—DEPARTMENT OF

DEFENSE AUTHORIZATIONS

* * * * * * *

TITLE VII—HEALTH CARE PROVISIONS

* * * * * * *

Subtitle C—Uniformed Services Treatment Facilities

SEC. 721. ø10 U.S.C. 1073 note¿ 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 55 of title 10, 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; 42

U.S.C. 248b) and that, before the date of the enactment of this

Act, was deemed to be a facility of the uniformed services for

the purposes of chapter 55 of title 10, 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 55 of title 10, United

States Code, principally section 1097 of such title, and includes

the competitive selection of contractors to financially under-
Sec. 722 P.L. 104–201 (DEFENSE AUTHORIZATION, FY97) 144

write the delivery of health care services under the Civilian

Health and Medical Program of the Uniformed Services.

SEC. 722. ø10 U.S.C. 1073 note¿ 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 (41 U.S.C. 421(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 under section 718(c) of the National

Defense Authorization Act for Fiscal Year 1991 (Public Law 101–

510; 42 U.S.C. 248c) 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 (42 U.S.C. 1395mm). The Secretary and the designated pro-
145 Sec. 724 P.L. 104–201 (DEFENSE AUTHORIZATION, FY97)

vider 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.

(g) CONTINUED ACQUISITION OF REDUCED-COST DRUGS.—A designated provider shall be treated as part of the Department of Defense for purposes of section 8126 of title 38, 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; 42 U.S.C. 248c note) or pursuant to the

agreement entered into under subsection (b).

SEC. 723. ø10 U.S.C. 1073 note¿ 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; 10

U.S.C. 1073 note), 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. ø10 U.S.C. 1073 note¿ 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 1074(a) of title 10, 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
Sec. 724 P.L. 104–201 (DEFENSE AUTHORIZATION, FY97) 146

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) do not have other primary health insurance coverage

(other than Medicare coverage) covering basic primary care

and inpatient and outpatient services;

(ii) 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

(iii) 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 newly enrolled by designated

providers pursuant to clause (ii) of subparagraph (A) during such

fiscal year may not exceed 10 percent of the total number of the

covered beneficiaries who are newly enrolled under such subparagraph during such 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

(42 U.S.C. 1395c 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.
147 Sec. 726 P.L. 104–201 (DEFENSE AUTHORIZATION, FY97)

(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. ø10 U.S.C. 1073 note¿ 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 1074(c) of title 10, 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.—Section 1074 of title 10, United

States Code, is amended by striking out subsection (d).

SEC. 726. ø10 U.S.C. 1073 note¿ 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
Sec. 727 P.L. 104–201 (DEFENSE AUTHORIZATION, FY97) 148

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. ø10 U.S.C. 1073 note¿ REPEAL OF SUPERSEDED AUTHORITIES.

(a) REPEALS.—The following provisions of law are repealed:

(1) Section 911 of the Military Construction Authorization

Act, 1982 (42 U.S.C. 248c).

(2) Section 1252 of the Department of Defense Authorization Act, 1984 (42 U.S.C. 248d).

(3) Section 718(c) of the National Defense Authorization

Act for Fiscal Year 1991 (Public Law 101–510; 42 U.S.C. 248c

note).

(4) Section 726 of the National Defense Authorization Act

for Fiscal Year 1996 (Public Law 104–106; 42 U.S.C. 248c

note).

(b) EFFECTIVE DATE.—The amendments made by paragraphs

(1), (2), and (3) of subsection (a) shall take effect on October 1,

1997.

* * * * * * *

Subtitle E—Other Matters

* * * * * * *

SEC. 742. ø10 U.S.C. 1071 note¿ EXTERNAL PEER REVIEW FOR DEFENSE

HEALTH PROGRAM EXTRAMURAL MEDICAL RESEARCH

INVOLVING HUMAN SUBJECTS.

(a) ESTABLISHMENT OF EXTERNAL PEER REVIEW PROCESS.—The

Secretary of Defense shall establish a peer review process that will

use persons who are not officers or employees of the Government

to review the research protocols of medical research projects.

(b) PEER REVIEW REQUIREMENTS.—Funds of the Department of

Defense may not be obligated or expended for any medical research

project unless the research protocol for the project has been ap-
149 Sec. 743 P.L. 104–201 (DEFENSE AUTHORIZATION, FY97)

proved by the external peer review process established under subsection (a).

(c) MEDICAL RESEARCH PROJECT DEFINED.—For purposes of

this section, the term ‘‘medical research project’’ means a research

project that—

(1) involves the participation of human subjects;

(2) is conducted solely by a non-Federal entity; and

(3) is funded through the Defense Health Program account.

(d) EFFECTIVE DATE.—The peer review requirements of subsection (b) shall take effect on October 1, 1996, and, except as provided in subsection (e), shall apply to all medical research projects

proposed funded on or after that date, including medical research

projects funded pursuant to any requirement of law enacted before,

on, or after that date.

(e) EXCEPTIONS.—Only the following medical research projects

shall be exempt from the peer review requirements of subsection (b):

(1) A medical research project that the Secretary determines has been substantially completed by October 1, 1996.

(2) A medical research project funded pursuant to any provision of law enacted on or after that date if the provision of

law specifically refers to this section and specifically states

that the peer review requirements do not apply.

SEC. 743. ø10 U.S.C. 1074 note¿ INDEPENDENT RESEARCH REGARDING

GULF WAR SYNDROME.

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

(1) The term ‘‘Gulf War service’’ means service on active

duty as a member of the Armed Forces in the Southwest Asia

theater of operations during the Persian Gulf War.

(2) The term ‘‘Gulf War syndrome’’ means the complex of

illnesses and symptoms commonly known as Gulf War syndrome.

(3) The term ‘‘Persian Gulf War’’ has the meaning given

that term in section 101(33) of title 38, United States Code.

(b) RESEARCH.—The Secretary of Defense shall provide, by contract, grant, or other transaction, for scientific research to be carried out by entities independent of the Federal Government on possible causal relationships between Gulf War syndrome and—

(1) the possible exposures of members of the Armed Forces

to chemical warfare agents or other hazardous materials during Gulf War service; and

(2) the use by the Department of Defense during the Persian Gulf War of combinations of various inoculations and investigational new drugs.

(c) PROCEDURES FOR AWARDING GRANTS.—The Secretary shall

prescribe the procedures to be used to make research awards under

subsection (b). The procedures shall—

(1) include a comprehensive, independent peer-review

process for the evaluation of proposals for scientific research

that are submitted to the Department of Defense; and

(2) provide for the final selection of proposals for award to

be based on the scientific merit and program relevance of the

proposed research.
Sec. 743 P.L. 104–201 (DEFENSE AUTHORIZATION, FY97) 150

(d) AVAILABILITY OF FUNDS.—Of the amount authorized to be

appropriated under section 301(21) for defense medical programs,

$10,000,000 is available for research under subsection (b).
151

NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEAR 1996

(P.L. 104–106, approved Feb. 10, 1996)

DIVISION A—DEPARTMENT OF

DEFENSE AUTHORIZATIONS

* * * * * * *

TITLE VII—HEALTH CARE PROVISIONS

* * * * * * *

Subtitle B—TRICARE Program

SEC. 711. DEFINITION OF TRICARE PROGRAM.

For purposes of this subtitle, the term ‘‘TRICARE program’’

means the managed health care program that is established by the

Secretary of Defense under the authority of chapter 55 of title 10,

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. 715. ø10 U.S.C. 1073 note¿ TRAINING IN HEALTH CARE MANAGEMENT AND ADMINISTRATION FOR TRICARE LEAD

AGENTS.

(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
Sec. 717 P.L. 104–106 (DEFENSE AUTHORIZATION, FY96) 152

of Defense that such person has completed the training described

in subsection (a).

* * * * * * *

SEC. 717. ø10 U.S.C. 1073 note¿ EVALUATION AND REPORT ON TRICARE

PROGRAM EFFECTIVENESS.

(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 55 of title 10, 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.

* * * * * * *

Subtitle E—Other Matters

* * * * * * *

SEC. 743. ø10 U.S.C. 1086 note¿ WAIVER OF COLLECTION OF PAYMENTS

DUE FROM CERTAIN PERSONS UNAWARE OF LOSS OF

CHAMPUS ELIGIBILITY.

(a) AUTHORITY TO WAIVE COLLECTION.—The administering

Secretaries may waive the collection of payments otherwise due

from a person described in subsection (b) as a result of the receipt

by the person of health benefits under section 1086 of title 10,

United States Code, after the termination of the person’s eligibility

for such benefits.

(b) PERSONS ELIGIBLE FOR WAIVER.—A person shall be eligible

for relief under subsection (a) if the person—

(1) is a person described in paragraph (1) of subsection (d)

of section 1086 of title 10, United States Code;

(2) in the absence of such paragraph, would have been eligible for health benefits under such section; and

(3) at the time of the receipt of such benefits, satisfied the

criteria specified in subparagraphs (A) and (B) of paragraph (2)

of such subsection.

(c) EXTENT OF WAIVER AUTHORITY.—The authority to waive the

collection of payments pursuant to this section shall apply with regard to health benefits provided under section 1086 of title 10,

United States Code, to persons described in subsection (b) during
153 Sec. 743 P.L. 104–106 (DEFENSE AUTHORIZATION, FY96)

the period beginning on January 1, 1967, and ending on the later

of—

(1) the termination date of any special enrollment period

provided under title XVIII of the Social Security Act (42 U.S.C.

1395 et seq.) specifically for such persons; and

(2) July 1, 1996.

(d) DEFINITIONS.—For purposes of this section, the term ‘‘administering Secretaries’’ has the meaning given such term in section 1072(3) of title 10, United States Code.
154

NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEAR 1995

(P.L. 103–337, approved Oct. 5, 1994)

DIVISION A—DEPARTMENT OF

DEFENSE AUTHORIZATIONS

* * * * * * *

TITLE VII—HEALTH CARE PROVISIONS

* * * * * * *

Subtitle A—Health Care Services

* * * * * * *

SEC. 704. AUTHORIZATION FOR MEDICAL AND DENTAL CARE FOR

ABUSED DEPENDENTS OF CERTAIN MEMBERS.

[Subsections (a) and (b) consisted of amendments.]

(c) ø10 U.S.C. 1091 note¿ PERSONAL SERVICE CONTRACTS TO

PROVIDE CARE.—(1) The Secretary of Defense may enter into personal service contracts under the authority of section 1091 of title

10, United States Code, with persons described in paragraph (2) to

provide the services of clinical counselors, family advocacy program

staff, and victim’s services representatives to members of the

Armed Forces and covered beneficiaries who require such services.

Notwithstanding subsection (a) of such section, such services may

be provided in medical treatment facilities of the Department of

Defense or elsewhere as determined appropriate by the Secretary.

(2) The persons with whom the Secretary may enter into a personal services contract under this subsection shall include clinical

social workers, psychologists, psychiatrists, and other comparable

professionals who have advanced degrees in counseling or related

academic disciplines and who meet all requirements for State licensure and board certification requirements, if any, within their

fields of specialization.

Subtitle C—Persian Gulf Illness

* * * * * * *

SEC. 721. ø10 U.S.C. 1074 note¿ PROGRAMS RELATED TO DESERT STORM

MYSTERY ILLNESS.

(a) OUTREACH PROGRAM TO PERSIAN GULF VETERANS AND FAM- ILIES.—The Secretary of Defense shall institute a comprehensive

outreach program to inform members of the Armed Forces who

served in the Southwest Asia theater of operations during the Persian Gulf Conflict, and the families of such members, of illnesses

that may result from such service. The program shall be carried

out through both medical and command channels, as well as any
155 Sec. 721 P.L. 103–337 (DEFENSE AUTHORIZATION, FY95)

other means the Secretary considers appropriate. Under the program, the Secretary shall—

(1) inform such individuals regarding—

(A) common disease symptoms reported by Persian

Gulf veterans that may be due to service in the Southwest

Asia theater of operations;

(B) blood donation policy;

(C) available counseling and medical care for such

members; and

(D) possible health risks to children of Persian Gulf

veterans;

(2) inform such individuals of the procedures for registering in either the Persian Gulf Veterans Health Surveillance System of the Department of Defense or the Persian Gulf

War Health Registry of the Department of Veterans Affairs;

and

(3) encourage such members to report any symptoms they

may have and to register in the appropriate health surveillance registry.

(b) INCENTIVES TO PERSIAN GULF VETERANS TO REGISTER.—In

order to encourage Persian Gulf veterans to register any symptoms

they may have in one of the existing health registries, the Secretary of Defense shall provide the following:

(1) For any Persian Gulf veteran who is on active duty and

who registers with the Department of Defense’s Persian Gulf

War Veterans Health Surveillance System, a full medical evaluation and any required medical care.

(2) For any Persian Gulf War veteran who is, as of the

date of the enactment of this Act, a member of a reserve component, opportunity to register at a military medical facility in

the Persian Gulf Veterans Health Care Surveillance System

and, in the case of a Reserve who registers in that registry, a

full medical evaluation by the Department of Defense. Depending on the results of the evaluation and on eligibility status,

reserve personnel may be provided medical care by the Department of Defense.

(3) For a Persian Gulf veteran who is not, as of the date

of the enactment of this Act, on active duty or a member of a

reserve component, assistance and information at a military

medical facility on registering with the Persian Gulf War Registry of the Department of Veterans Affairs and information related to support services provided by the Department of Veterans Affairs.

(c) COMPATIBILITY OF DEPARTMENT OF DEFENSE AND DEPARTMENT OF VETERANS AFFAIRS REGISTRIES.—The Secretary of Defense

shall take appropriate actions to ensure—

(1) that the data collected by and the testing protocols of

the Persian Gulf War Health Surveillance System maintained

by the Department of Defense are compatible with the data

collected by and the testing protocols of the Persian Gulf War

Veterans Health Registry maintained by the Department of

Veterans Affairs; and

(2) that all information on individuals who register with

the Department of Defense for purposes of the Persian Gulf
Sec. 721 P.L. 103–337 (DEFENSE AUTHORIZATION, FY95) 156

War Health Surveillance System is provided to the Secretary

of Veterans Affairs for incorporation into the Persian Gulf War

Veterans Health Registry.

(d) PRESUMPTIONS ON BEHALF OF SERVICE MEMBER.—(1) A

member of the Armed Forces who is a Persian Gulf veteran, who

has symptoms of illness, and who the Secretary concerned finds

may have become ill as a result of serving on active duty in the

Southwest Asia theater of operations during the Persian Gulf War

shall be considered for Department of Defense purposes to have become ill as a result of serving in that theater of operations.

(2) A member of the Armed Forces who is a Persian Gulf veteran and who reports being ill as a result of serving on active duty

in the Southwest Asia theater of operations during the Persian

Gulf War shall be considered for Department of Defense purposes

to have become ill as a result of serving in that theater of operations until such time as the weight of medical evidence establishes

other cause or causes of the member’s illness.

(3) The Secretary concerned shall ensure that, for the purposes

of health care treatment by the Department of Defense, health care

and personnel administration, and disability evaluation by the Department of Defense, the symptoms of any member of the Armed

Forces covered by paragraph (1) or (2) are examined in light of the

member’s service in the Persian Gulf War and in light of the reported symptoms of other Persian Gulf veterans. The Secretary

shall ensure that, in providing health care diagnosis and treatment

of the member, a broad range of potential causes of the member’s

symptoms are considered and that the member’s symptoms are

considered collectively, as well as by type of symptom or medical

specialty, and that treatment across medical specialties is coordinated appropriately.

(4) The Secretary of Defense shall ensure that the presumptions of service connection and illness specified in paragraphs (1)

and (2) are incorporated in appropriate service medical and personnel regulations and are widely disseminated throughout the Department of Defense.

(e) REVISION OF THE PHYSICAL EVALUATION BOARD CRITERIA.—

(1) The Secretary of Defense, in consultation with the Secretary of

Veterans Affairs and the Secretary of Health and Human Services,

shall ensure that case definitions of Persian Gulf related illnesses,

as well as the Physical Evaluation Board criteria used to set disability ratings for members no longer medically qualified for continuation on active duty, are established as soon as possible to permit accurate disability ratings related to a diagnosis of Persian

Gulf illnesses.

(2) Until revised disability criteria can be implemented and

members of the Armed Forces can be rated against those criteria,

the Secretary of Defense shall ensure—

(A) that any member of the Armed Forces on active duty

who may be suffering from a Persian Gulf-related illness is afforded continued military medical care; and

(B) that any member of the Armed Forces on active duty

who is found by a Physical Evaluation Board to be unfit for

continuation on active duty as a result of a Persian Gulf-related illness for which the board has no rating criteria (or inad-
157 Sec. 721 P.L. 103–337 (DEFENSE AUTHORIZATION, FY95)

equate rating criteria) for the illness or condition from which

the member suffers is placed on the temporary disability retired list.

(f) REVIEW OF RECORDS AND RERATING OF PREVIOUSLY DISCHARGED GULF WAR VETERANS.—(1) The Secretary of Defense, in

consultation with the Secretary of Veterans Affairs, shall ensure

that a review is made of the health and personnel records of each

Persian Gulf veteran who before the date of the enactment of this

Act was discharged from active duty, or was medically retired, as

a result of a Physical Evaluation Board process.

(2) The review under paragraph (1) shall be carried out to ensure that former Persian Gulf veterans who may have been suffering from a Persian Gulf-related illness at the time of discharge

or retirement from active duty as a result of the Physical Evaluation Board process are reevaluated in accordance with the criteria

established under subsection (e)(1) and, if appropriate, are rerated.

(g) PERSIAN GULF ILLNESS MEDICAL REFERRAL CENTERS.—The

Secretary of Defense shall evaluate the feasibility of establishing

one or more medical referral centers to provide uniform, coordinated medical care for Persian Gulf veterans on active duty who

are or may be suffering from a Persian Gulf-related illness. The

Secretary shall submit a report on such feasibility to the Committees on Armed Services of the Senate and House of Representatives

not later than six months after the date of the enactment of this

Act.

(h) ANNUAL REPORT TO CONGRESS.—øRepealed by section

1031(e) of P.L. 108–136¿

(i) PERSIAN GULF VETERAN.—For purposes of this section, a

Persian Gulf veteran is an individual who served on active duty in

the Armed Forces in the Southwest Asia theater of operations during the Persian Gulf Conflict.
158

NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEAR 1994

(P.L. 103–160, approved Nov. 30, 1993)

DIVISION A—DEPARTMENT OF

DEFENSE AUTHORIZATIONS

* * * * * * *

TITLE VII—HEALTH CARE PROVISIONS

* * * * * * *

SEC. 731. ø10 U.S.C. 1073 note¿ USE OF HEALTH MAINTENANCE ORGANIZATION MODEL AS OPTION FOR MILITARY HEALTH

CARE.

(a) USE OF MODEL.—The Secretary of Defense shall prescribe

and implement a health benefit option (and accompanying costsharing requirements) for covered beneficiaries eligible for health

care under chapter 55 of title 10, 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 1079 or 1086 of title 10,

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 55 of title 10, 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 55 of title 10, United
159 FY94 P.L. 103–160 (DEFENSE AUTHORIZATION, FY94)

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).
160

NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEAR 1993

(P.L. 102–484, approved Oct. 23, 1992)

DIVISION A—DEPARTMENT OF

DEFENSE AUTHORIZATIONS

* * * * * * *

TITLE VII—HEALTH CARE PROVISIONS

* * * * * * *

Subtitle A—Health Care Services

* * * * * * *

SEC. 702. ø10 U.S.C. 1079 note¿ PROGRAMS RELATING TO THE SALE OF

PHARMACEUTICALS.

(a) DEMONSTRATION PROJECT FOR PHARMACEUTICALS BY

MAIL.—Not later than 18 months after the date of the enactment

of this Act, the Secretary of Defense, in consultation with the administering Secretaries, shall—

(1) establish a demonstration project that permits eligible

persons described in subsection (c) to obtain prescription pharmaceuticals by mail in connection with medical care furnished

to such persons under chapter 55 of title 10, United States

Code; and

(2) conduct the demonstration project in two or more regions selected by the Secretary, each of which consists of two

or more States.

(b) RETAIL PHARMACY NETWORK.—To the maximum extent

practicable, the Secretary of Defense shall include in each managed

health care program initiated, awarded, or renewed by the Secretary after January 1, 1993, a program to supply prescription

pharmaceuticals to eligible persons described in subsection (c)

through a managed care network of community retail pharmacies

in the area covered by the managed health care program.

(c) ELIGIBLE PERSONS.—A person eligible to obtain pharmaceuticals under the demonstration project established under subsection (a) or the retail pharmacy network included in a managed

health care program under subsection (b) is any person living in

the area covered by the demonstration project or managed health

care program—

(1) who is eligible for medical care under a contract for

medical care entered into by the Secretary of Defense under

section 1079 or 1086 of title 10, United States Code; or

(2) who—
161 Sec. 702 P.L. 102–484 (DEFENSE AUTHORIZATION, FY93)

(A) would be eligible for medical care under a contract

for medical care entered into under section 1086 of such

title except for operation of subsection (d)(1) of such section; and

(B) either—

(i) resides in an area that is adversely affected (as

determined by the Secretary) by the closure of a

health care facility of the uniformed services as a result of the closure or realignment of the military installation at which such facility is located; or

(ii) can demonstrate to the satisfaction of the Secretary that the person relied upon a health care facility referred to in clause (i) before the closure of the facility to obtain the person’s pharmaceuticals.

(d) PHARMACEUTICALS OFFERED; PURCHASE FEES.—(1) The Secretary of Defense, in consultation with the administering Secretaries, shall—

(A) determine the pharmaceuticals that may be obtained

by eligible persons under the demonstration project established

under subsection (a) or the retail pharmacy network included

in a managed health care program under subsection (b); and

(B) establish an appropriate fee, charge, or copayment to

be paid by such persons for pharmaceuticals obtained under

the demonstration project or managed health care program.

(2) In the case of persons eligible to participate in the demonstration project for pharmaceuticals or the retail pharmacy network by reason of clause (ii) of subsection (c)(2)(B), the Secretary

of Defense may increase the fees, charges, and copayments established under paragraph (1)(B) and otherwise applicable to such persons by an amount necessary to cover any additional costs incurred

by the administering Secretaries as a result of making pharmaceuticals available to such persons under this section.

(e) REPORT REGARDING DEMONSTRATION PROJECT.—Not later

than two years after the establishment of the demonstration project

under subsection (a), the Secretary of Defense shall submit to Congress a report—

(1) describing the results of the demonstration project required by subsection (a);

(2) containing such recommendations for revision of the

demonstration project as the Secretary considers to be necessary; and

(3) containing a plan (including a schedule) for implementing the demonstration project throughout the United

States.

(f) ADDITIONAL REPORT REGARDING PROGRAMS.—Not later than

January 1, 1994, the Secretary of Defense shall submit to Congress

a report containing—

(1) an evaluation of the feasibility and advisability of increasing the size of those areas determined by the Secretary

under subsection (c)(2) to be adversely affected by the closure

of a health care facility of the uniformed services in order to

increase the number of persons described in such subsection

who will be eligible to participate in the demonstration project
Sec. 711 P.L. 102–484 (DEFENSE AUTHORIZATION, FY93) 162

for pharmaceuticals by mail or in the retail pharmacy network

under this section;

(2) an evaluation of the feasibility and advisability of expanding the demonstration project and the retail pharmacy

network under this section to include all covered beneficiaries

under chapter 55 of title 10, United States Code, including

those persons currently excluded from participation in the Civilian Health and Medical Program of the Uniformed Services

by operation of section 1086(d)(1) of such title;

(3) an estimation of the costs that would be incurred, and

any savings that would be achieved by improving efficiencies

of operation, as a result of undertaking the increase or expansion described in paragraph (1) or (2); and

(4) such recommendations as the Secretary considers to be

appropriate.

(g) DEFINITIONS.—In this section, the terms ‘‘uniformed services’’ and ‘‘administering Secretaries’’ have the meanings given

those terms in section 1072 of title 10, United States Code.

(h) TERMINATION.—This section shall cease to apply to the Secretary of Defense on the date after the implementation of section

711 of the Floyd D. Spence National Defense Authorization Act for

Fiscal Year 2001 that the Secretary determines appropriate, with

a view to minimizing instability with respect to the provision of

pharmacy benefits, but in no case later than the date that is one

year after the date of the enactment of such Act.

* * * * * * *

Subtitle B—Health Care Management

SEC. 711. ø10 U.S.C. 1106 note¿ NATIONAL CLAIMS PROCESSING SYSTEM FOR CHAMPUS.

(a) CLAIMS PROCESSING SYSTEM REQUIRED.—(1) The Secretary

of Defense, in consultation with the other administering Secretaries, shall provide by contract for the operation of a claims processing system to be known as the ‘‘National Claims Processing System for CHAMPUS’’. The Secretary may procure the system in installments, including the use of incremental modules. The system,

including completion and integration of all modules, shall be in full

operation not later than seven years after the date of the enactment of this Act.

(2) The Secretary shall use competitive procedures for entering

into any contract or contracts under paragraph (1).

(b) SYSTEM FUNCTIONS.—The claims processing system shall

include at least the following functions:

(1) The maintenance in electronic or written form, or both,

of appropriate information on health care services provided to

covered beneficiaries by or through third parties under

CHAMPUS or any alternative CHAMPUS program or demonstration project. Such information shall include—

(A) the services to which such beneficiaries are entitled or eligible under an insurance plan, medical service

plan, or health plan under CHAMPUS;

(B) the insurers, medical services, or health plans that

provide such services; and
163 Sec. 712 P.L. 102–484 (DEFENSE AUTHORIZATION, FY93)

(C) the services available to beneficiaries under each

insurance plan, medical service plan, or health plan, and

the payment required of the beneficiaries and the insurer,

medical service, or health plan for such services under the

plan.

(2) The ability to receive in electronic or written form

claims submitted by insurers, medical services, and health

plans for services provided to covered beneficiaries.

(3) The ability to process, adjudicate, and pay (by electronic or other means) such claims.

(4) The provision of the information described in paragraphs (1) and (2) and information on the matters referred to

in paragraph (3) by telephone, electronic, or other means to

covered beneficiaries, insurers, medical services, and health

plans.

(c) CONSISTENCY WITH MEDICARE CLAIMS REQUIREMENTS.—The

Secretary of Defense shall ensure, to the maximum extent practicable, that claims submitted to the claims processing system conform to the requirements applicable to claims submitted to the Secretary of Health and Human Services with respect to medical care

provided under part A of title XVIII of the Social Security Act (42

U.S.C. 1395c et seq.).

(d) IDENTIFICATION CARD.—The Secretary of Defense shall take

appropriate actions to determine whether the use by covered beneficiaries of a standard identification card containing electronically

readable information will enhance the capability of the claims processing center to carry out the activities set forth in subsection (b).

(e) TRANSITION TO SYSTEM.—After January 1, 1996, any modification or acquisition related to claims processing systems operations in the Office of the Civilian Health and Medical Program of

the Uniformed Services shall contain provisions to transfer such

operations to the claims processing system required by subsection

(a). After January 1, 1999, any renewal or acquisition for fiscal

intermediary services (including coordinated care implementations

in military hospitals and clinics) shall contain provisions to transfer claims processing systems operations related to such fiscal

intermediary services to the claims processing system required by

subsection (a).

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

(1) The term ‘‘administering Secretaries’’ has the meaning

given that term in paragraph (3) of section 1072 of title 10,

United States Code.

(2) The term ‘‘CHAMPUS’’ means the Civilian Health and

Medical Program of the Uniformed Services, as defined in

paragraph (4) of such section.

(3) The term ‘‘covered beneficiary’’ has the meaning given

that term in paragraph (5) of such section.

SEC. 712. ø10 U.S.C. 1073 note¿ CONDITION ON EXPANSION OF

CHAMPUS REFORM INITIATIVE TO OTHER LOCATIONS.

(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
FY93 P.L. 102–484 (DEFENSE AUTHORIZATION, FY93) 164

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; 10 U.S.C. 1073 note).

(2) The term ‘‘covered beneficiary’’ has the meaning given

that term in section 1072(5) of title 10, 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 1072(4) of title 10, United States

Code.

* * * * * * *

SEC. 715. POSITIVE INCENTIVES UNDER THE COORDINATED CARE

PROGRAM.

(a) INCLUSION OF POSITIVE INCENTIVES FOR ENROLLMENT.—The

Secretary of Defense shall modify the Policy Guidelines on the Department of Defense Coordinated Care Program to provide covered

beneficiaries with additional positive incentives to enroll in the Coordinated Care Program of the Department of Defense.
165 Sec. 715 P.L. 102–484 (DEFENSE AUTHORIZATION, FY93)

(b) TYPES OF POSITIVE INCENTIVES.—The positive incentives

provided under subsection (a) may include—

(1) a reduction of the copayment and deductibles prescribed under sections 1079 and 1086 of title 10, United States

Code, for covered beneficiaries who enroll in the Coordinated

Care Program;

(2) alternative cost-sharing requirements for certain types

of care; and

(3) an expansion of the benefits provided under the Coordinated Care Program beyond the benefits authorized under

CHAMPUS.

(c) EFFECT ON CERTAIN EXISTING PROGRAMS.—The modification

required under subsection (a) shall permit health care demonstration projects in existence on the date of the enactment of this Act

(including the CHAMPUS reform initiative, the catchment area

management projects, the CHAMPUS select fiscal intermediary

program in the Southeast Region, and the managed health care

program established in the Tidewater region of Virginia) and future managed health care initiatives undertaken by the Department of Defense to offer covered beneficiaries who do not enroll in

the Coordinated Care Program the opportunity to use a preferred

provider network of health care providers.

(d) DETERMINATION OF INCENTIVES.—In determining what level

and types of positive incentives are likely to induce covered beneficiaries to enroll in the Coordinated Care Program, the Secretary

of Defense shall take into consideration the extent to which covered

beneficiaries not enrolled in the program are permitted to choose

health care providers without prior referral or approval.

(e) PROHIBITION ON EXCLUSIONS.—Subject to the availability of

space and facilities and the capabilities of the medical or dental

staff, the Secretary of Defense may not deny access to military

treatment facilities to covered beneficiaries who do not enroll in the

Coordinated Care Program. However, the Secretary may establish

reasonable admission preferences for covered beneficiaries enrolled

in the program as an incentive to encourage enrollment.

(f) 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 1072 of title 10, United States Code.

(2) The term ‘‘covered beneficiary’’ has the meaning given

that term in paragraph (5) of such section.

(3) The term ‘‘Policy Guidelines on the Department of Defense Coordinated Care Program’’ means the Policy Guidelines

on the Department of Defense Coordinated Care Program that

were issued by the Assistant Secretary of Defense for Health

Affairs on January 8, 1992.

* * * * * * *

Subtitle C—Other Matters

* * * * * * *
Sec. 722 P.L. 102–484 (DEFENSE AUTHORIZATION, FY93) 166

SEC. 722. ø10 U.S.C. 1073 note¿ MILITARY HEALTH CARE FOR PERSONS

RELIANT ON HEALTH CARE FACILITIES AT BASES BEING

CLOSED OR REALIGNED.

(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; 10 U.S.C. 2687 note), as added

by title XXX of the National Defense Authorization Act for Fiscal Year 2002 (Public Law 107–107; 155 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 55 of title 10, 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, 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 55 of title 10, 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 55 of title 10, 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
167 Sec. 724 P.L. 102–484 (DEFENSE AUTHORIZATION, FY93)

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.

* * * * * * *

SEC. 724. ø10 U.S.C. 1071 note¿ ANNUAL BENEFICIARY SURVEY.

(a) SURVEY REQUIRED.—The administering Secretaries shall

conduct annually a formal survey of persons receiving health care

under chapter 55 of title 10, United States Code, in order to determine the following:

(1) The availability of health care services to such persons

through the health care system provided for under that chapter, the types of services received, and the facilities in which

the services were provided.

(2) The familiarity of such persons with the services available under that system and with the facilities in which such

services are provided.

(3) The health of such persons.

(4) The level of satisfaction of such persons with that system and the quality of the health care provided through that

system.

(5) Such other matters as the administering Secretaries

determine appropriate.

(b) EXEMPTION.—An annual survey under subsection (a) shall

be treated as not a collection of information for the purposes for

which such term is defined in section 3502(4) of title 44, United

States Code.

(c) DEFINITION.—For purposes of this section, the term ‘‘administering Secretaries’’ has the meaning given such term in section

1072(3) of title 10, United States Code.
168

NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEARS 1992

AND 1993

(P.L. 102–190, approved Dec. 5, 1991)

DIVISION A—DEPARTMENT OF

DEFENSE AUTHORIZATIONS

* * * * * * *

TITLE VII—HEALTH CARE PROVISIONS

* * * * * * *

PART B—HEALTH CARE MANAGEMENT

* * * * * * *

SEC. 722. ø10 U.S.C. 1073 note¿ AUTHORIZATION FOR THE EXTENSION

OF CHAMPUS REFORM INITIATIVE.

(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 under the CHAMPUS reform initiative established under section 702 of the National Defense Authorization Act

for Fiscal Year 1987 (10 U.S.C. 1073 note), 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.

* * * * * * *

PART C—MISCELLANEOUS

* * * * * * *

SEC. 734. ø10 U.S.C. 1074 note¿ REGISTRY OF MEMBERS OF THE ARMED

FORCES EXPOSED TO FUMES OF BURNING OIL IN CONNECTION WITH OPERATION DESERT STORM.

(a) ESTABLISHMENT OF REGISTRY.—The Secretary of Defense

shall establish and maintain a special record (in this section referred to as the ‘‘Registry’’) relating to the following members of the

Armed Forces:
169 Sec. 734 P.L. 102–190 (DEFENSE AUTHORIZATION, FY92/93)

(1) Members who, as determined by the Secretary, were

exposed to the fumes of burning oil in the Operation Desert

Storm theater of operations during the Persian Gulf conflict.

(2) Any other members who served in the Operation

Desert Storm theater of operations during the Persian Gulf

conflict.

(b) CONTENTS OF REGISTRY.—(1) The Registry shall include—

(A) with respect to each class of members referred to in

each of paragraphs (1) and (2) of subsection (a)—

(i) a list containing each such member’s name and

other relevant identifying information with respect to the

member; and

(ii) to the extent that data are available and inclusion

of the data is feasible, a description of the circumstances

of the member’s service during the Persian Gulf conflict,

including the locations in the Operation Desert Storm theater of operations in which such service occurred and the

atmospheric and other environmental circumstances in

such locations at the time of such service; and

(B) with respect to the members referred to in subsection

(a)(1), a description of the circumstances of each exposure of

each such member to the fumes of burning oil as described in

such subsection (a)(1), including the length of time of the exposure.

(2) The Secretary shall establish the Registry with the advice

of an independent scientific organization.

(c) REPORTING REQUIREMENT RELATING TO EXPOSURE STUDIES.—

øRepealed by section 1031(c) of P.L. 108–136¿

(d) MEDICAL EXAMINATION.—Upon the request of any member

listed in the Registry pursuant to subsection (a)(1), the Secretary

of the military department concerned shall, if medically appropriate, furnish a pulmonary function examination and chest x-ray

to such person.

(e) EFFECTIVE DATE.—The Secretary shall establish the Registry

not later than 180 days after the date of the enactment of this Act.

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

(1) The term ‘‘Operation Desert Storm’’ has the meaning

given such term in section 3(1) of the Persian Gulf Conflict

Supplemental Authorization and Personnel Benefits Act of

1991 (Public Law 102–25; 105 Stat. 77; 10 U.S.C. 101 note).

(2) The term ‘‘Persian Gulf conflict’’ has the meaning given

such term in section 3(3) of such Act.
170

NATIONAL DEFENSE AUTHORIZATION ACT FOR FISCAL YEAR 1991

(P.L. 101–510, approved Nov. 5, 1990)

DIVISION A—DEPARTMENT OF

DEFENSE AUTHORIZATIONS

* * * * * * *

TITLE VII—HEALTH CARE PROVISIONS

* * * * * * *

SEC. 715. ø10 U.S.C. 1073 note¿ CONDITIONS ON EXPANSION OF

CHAMPUS REFORM INITIATIVE

(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 (10 U.S.C. 1073 note).
171

SELECTED HEALTH-RELATED PROVISIONS OF DEFENSE

APPROPRIATIONS ACTS
172

DEPARTMENT OF DEFENSE APPROPRIATIONS ACT, 2004

(P.L. 108–87, approved Sept. 30, 2003)

* * * * * * *

TITLE VIII

GENERAL PROVISIONS

* * * * * * *

SEC. 8009. Within the funds appropriated for the operation and

maintenance of the Armed Forces, funds are hereby appropriated

pursuant to section 401 of title 10, United States Code, for humanitarian and civic assistance costs under chapter 20 of title 10,

United States Code. Such funds may also be obligated for humanitarian and civic assistance costs incidental to authorized operations

and pursuant to authority granted in section 401 of chapter 20 of

title 10, United States Code, and these obligations shall be reported

as required by section 401(d) of title 10, United States Code: Provided, That funds available for operation and maintenance shall be

available for providing humanitarian and similar assistance by

using Civic Action Teams in the Trust Territories of the Pacific Islands and freely associated states of Micronesia, pursuant to the

Compact of Free Association as authorized by Public Law 99–239:

Provided further, That upon a determination by the Secretary of

the Army that such action is beneficial for graduate medical education programs conducted at Army medical facilities located in

Hawaii, the Secretary of the Army may authorize the provision of

medical services at such facilities and transportation to such facilities, on a nonreimbursable basis, for civilian patients from American Samoa, the Commonwealth of the Northern Mariana Islands,

the Marshall Islands, the Federated States of Micronesia, Palau,

and Guam.

* * * * * * *

SEC. 8017. None of the funds appropriated by this Act available for the Civilian Health and Medical Program of the Uniformed

Services (CHAMPUS) or TRICARE shall be available for the reimbursement of any health care provider for inpatient mental health

service for care received when a patient is referred to a provider

of inpatient mental health care or residential treatment care by a

medical or health care professional having an economic interest in

the facility to which the patient is referred: Provided, That this

limitation does not apply in the case of inpatient mental health

services provided under the program for persons with disabilities

under subsection (d) of section 1079 of title 10, United States Code,

provided as partial hospital care, or provided pursuant to a waiver

authorized by the Secretary of Defense because of medical or psychological circumstances of the patient that are confirmed by a
173 Sec. 8089 P.L. 108–87 (DEFENSE APPROPRIATIONS, FY04)

health professional who is not a Federal employee after a review,

pursuant to rules prescribed by the Secretary, which takes into account the appropriate level of care for the patient, the intensity of

services required by the patient, and the availability of that care.

* * * * * * *

SEC. 8024. Notwithstanding any other provision of law or regulation, the Secretary of Defense may adjust wage rates for civilian

employees hired for certain health care occupations as authorized

for the Secretary of Veterans Affairs by section 7455 of title 38,

United States Code.

* * * * * * *

SEC. 8026. During the current fiscal year, net receipts pursuant to collections from third party payers pursuant to section 1095

of title 10, United States Code, shall be made available to the local

facility of the uniformed services responsible for the collections and

shall be over and above the facility’s direct budget amount.

* * * * * * *

SEC. 8054. During the current fiscal year, none of the funds appropriated in this Act may be used to reduce the civilian medical

and medical support personnel assigned to military treatment facilities below the September 30, 2002 level: Provided, That the

Service Surgeons General may waive this section by certifying to

the congressional defense committees that the beneficiary population is declining in some catchment areas and civilian strength

reductions may be consistent with responsible resource stewardship

and capitation-based budgeting.

* * * * * * *

SEC. 8060. Notwithstanding any other provision of law, funds

available to the Department of Defense shall be made available to

provide transportation of medical supplies and equipment, on a

nonreimbursable basis, to American Samoa, and funds available to

the Department of Defense shall be made available to provide

transportation of medical supplies and equipment, on a nonreimbursable basis, to the Indian Health Service when it is in conjunction with a civil-military project.

* * * * * * *

SEC. 8078. The Secretary of Defense, in coordination with the

Secretary of Health and Human Services, may carry out a program

to distribute surplus dental equipment of the Department of Defense, at no cost to the Department of Defense, to Indian Health

Service facilities and to federally-qualified health centers (within

the meaning of section 1905(l)(2)(B) of the Social Security Act (42

U.S.C. 1396d(l)(2)(B))).

* * * * * * *

SEC. 8089. (a) The Department of Defense is authorized to

enter into agreements with the Department of Veterans Affairs and

federally-funded health agencies providing services to Native Hawaiians for the purpose of establishing a partnership similar to the

Alaska Federal Health Care Partnership, in order to maximize

Federal resources in the provision of health care services by federally-funded health agencies, applying telemedicine technologies.
Sec. 8093 P.L. 108–87 (DEFENSE APPROPRIATIONS, FY04) 174

For the purpose of this partnership, Native Hawaiians shall have

the same status as other Native Americans who are eligible for the

health care services provided by the Indian Health Service.

(b) The Department of Defense is authorized to develop a consultation policy, consistent with Executive Order No. 13084 (issued

May 14, 1998), with Native Hawaiians for the purpose of assuring

maximum Native Hawaiian participation in the direction and administration of governmental services so as to render those services

more responsive to the needs of the Native Hawaiian community.

(c) For purposes of this section, the term ‘‘Native Hawaiian’’

means any individual who is a descendant of the aboriginal people

who, prior to 1778, occupied and exercised sovereignty in the area

that now comprises the State of Hawaii.

* * * * * * *

SEC. 8093. In addition to amounts provided elsewhere in this

Act, $3,800,000 is hereby appropriated for ‘‘Defense Health Program’’, to remain available for obligation until expended: Provided,

That notwithstanding any other provision of law, $2,000,000 shall

be available only for a grant to the Fisher House Foundation, Inc.,

only for the construction and furnishing of additional Fisher

Houses to meet the needs of military family members when confronted with the illness or hospitalization of an eligible military

beneficiary, and notwithstanding any other provision of law,

$1,800,000 shall be available only for deposit into the Army, Navy,

and Air Force Fisher House Non-appropriated Fund Instrumentalities and shall be used in support and upkeep of existing Fisher

Houses.
175

DEPARTMENT OF DEFENSE APPROPRIATIONS ACT, 2001

(P.L. 106–259, approved Aug. 9, 2000)

* * * * * * *

SEC. 8090. ø10 U.S.C. 1073 note¿ 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.

177

MISCELLANEOUS DEFENSE-RELATED HEALTH LAWS

179

HEALTH CARE ISSUES RELATING TO GULF WAR

VETERANS

PERSIAN GULF WAR VETERANS’ BENEFITS ACT

(Title I of Public Law 103–446, approved Nov. 2, 1994)

TITLE I—PERSIAN GULF WAR VETERANS

SEC. 101. SHORT TITLE.

This Act may be cited as the ‘‘Persian Gulf War Veterans’ Benefits Act’’.

SEC. 102. ø38 U.S.C. 1117 note¿ FINDINGS.

The Congress makes the following findings:

(1) During the Persian Gulf War, members of the Armed

Forces were exposed to numerous potentially toxic substances,

including fumes and smoke from military operations, oil well

fires, diesel exhaust, paints, pesticides, depleted uranium, infectious agents, investigational drugs and vaccines, and indigenous diseases, and were also given multiple immunizations. It

is not known whether these servicemembers were exposed to

chemical or biological warfare agents. However, threats of

enemy use of chemical and biological warfare heightened the

psychological stress associated with the military operation.

(2) Significant numbers of veterans of the Persian Gulf

War are suffering from illnesses, or are exhibiting symptoms

of illness, that cannot now be diagnosed or clearly defined. As

a result, many of these conditions or illnesses are not considered to be service connected under current law for purposes of

benefits administered by the Department of Veterans Affairs.

(3) The National Institutes of Health Technology Assessment Workshop on the Persian Gulf Experience and Health,

held in April 1994, concluded that the complex biological,

chemical, physical, and psychological environment of the

Southwest Asia theater of operations produced complex adverse health effects in Persian Gulf War veterans and that no

single disease entity or syndrome is apparent. Rather, it may

be that the illnesses suffered by those veterans result from

multiple illnesses with overlapping symptoms and causes that

have yet to be defined.

(4) That workshop concluded that the information concerning the range and intensity of exposure to toxic substances

by military personnel in the Southwest Asia theater of operations is very limited and that such information was collected

only after a considerable delay.

(5) In response to concerns regarding the health-care needs

of Persian Gulf War veterans, particularly those who suffer
Sec. 103 GULF WAR HEALTH ISSUES 180

from illnesses or conditions for which no diagnosis has been

made, the Congress, in Public Law 102–585, directed the establishment of a Persian Gulf War Veterans Health Registry,

authorized health examinations for veterans of the Persian

Gulf War, and provided for the National Academy of Sciences

to conduct a comprehensive review and assessment of information regarding the health consequences of military service in

the Persian Gulf theater of operations and to develop recommendations on avenues for research regarding such health

consequences. In Public Law 103–210, the Congress authorized

the Department of Veterans Affairs to provide health care

services on a priority basis to Persian Gulf War veterans. The

Congress also provided in Public Law 103–160 (the National

Defense Authorization Act for Fiscal Year 1994) for the establishment of a specialized environmental medical facility for the

conduct of research into the possible health effects of exposure

to low levels of hazardous chemicals, especially among Persian

Gulf veterans, and for research into the possible health effects

of battlefield exposure in such veterans to depleted uranium.

(6) In response to concerns about the lack of objective research on Gulf War illnesses, Congress included research provisions in the National Defense Authorization Act for Fiscal

Year 1995, which was passed by the House and Senate in September 1994. This legislation requires the Secretary of Defense

to provide research grants to non-Federal researchers to support three types of studies of the Gulf War syndrome. The first

type of study will be an epidemiological study or studies of the

incidence, prevalence, and nature of the illness and symptoms

and the risk factors associated with symptoms or illnesses.

This will include illnesses among spouses and birth defects and

illnesses among offspring born before and after the Gulf War.

The second group of studies shall be conducted to determine

the health consequences of the use of pyridostigmine bromide

as a pretreatment antidote enhancer during the Persian Gulf

War, alone or in combination with exposure to pesticides, environmental toxins, and other hazardous substances. The final

group of studies shall include clinical research and other studies on the causes, possible transmission, and treatment of Gulf

War syndrome, and will include studies of veterans and their

spouses and children.

(7) Further research and studies must be undertaken to

determine the underlying causes of the illnesses suffered by

Persian Gulf War veterans and, pending the outcome of such

research, veterans who are seriously ill as the result of such

illnesses should be given the benefit of the doubt and be provided compensation benefits to offset the impairment in earnings capacities they may be experiencing.

SEC. 103. ø38 U.S.C. 1117 note¿ PURPOSES.

The purposes of this title are—

(1) to provide compensation to Persian Gulf War veterans

who suffer disabilities resulting from illnesses that cannot now

be diagnosed or defined, and for which other causes cannot be

identified;
181 Sec. 104 GULF WAR HEALTH ISSUES

(2) to require the Secretary of Veterans Affairs to develop

at the earliest possible date case assessment strategies and

definitions or diagnoses of such illnesses;

(3) to promote greater outreach to Persian Gulf War veterans and their families to inform them of ongoing research activities, as well as the services and benefits to which they are

currently entitled; and

(4) to ensure that research activities and accompanying

surveys of Persian Gulf War veterans are appropriately funded

and undertaken by the Department of Veterans Affairs.

SEC. 104. ø38 U.S.C. 1117 note¿ DEVELOPMENT OF MEDICAL EVALUATION PROTOCOL.

(a) UNIFORM MEDICAL EVALUATION PROTOCOL.—(1) The Secretary of Veterans Affairs shall develop and implement a uniform

and comprehensive medical evaluation protocol that will ensure appropriate medical assessment, diagnosis, and treatment of Persian

Gulf War veterans who are suffering from illnesses the origins of

which are (as of the date of the enactment of this Act) unknown

and that may be attributable to service in the Southwest Asia theater of operations during the Persian Gulf War. The protocol shall

include an evaluation of complaints relating to illnesses involving

the reproductive system.

(2) If such a protocol is not implemented before the end of the

120-day period beginning on the date of the enactment of this Act,

the Secretary shall, before the end of such period, submit to the

Committees on Veterans’ Affairs of the Senate and House of Representatives a report as to why such a protocol has not yet been

developed.

(3)(A) The Secretary shall ensure that the evaluation under the

protocol developed under this section is available at all Department

medical centers that have the capability of providing the medical

assessment, diagnosis, and treatment required under the protocol.

(B) The Secretary may enter into contracts with non-Department medical facilities for the provision of the evaluation under the

protocol.

(C) In the case of a veteran whose residence is distant from a

medical center described in subparagraph (A), the Secretary may

provide the evaluation through a Department medical center described in that subparagraph and, in such a case, may provide the

veteran the travel and incidental expenses therefor pursuant to the

provisions of section 111 of title 38, United States Code.

(4)(A) If the Secretary is unable to diagnose the symptoms or

illness of a veteran provided an evaluation, or if the symptoms or

illness of a veteran do not respond to treatment provided by the

Secretary, the Secretary may use the authority in section 1703 of

title 38, United States Code, in order to provide for the veteran to

receive diagnostic tests or treatment at a non-Department medical

facility that may have the capability of diagnosing or treating the

symptoms or illness of the veteran. The Secretary may provide the

veteran the travel and incidental expenses therefor pursuant to the

provisions of section 111 of title 38, United States Code.

(B) The Secretary shall request from each non-Department

medical facility that examines or treats a veteran under this paragraph such information relating to the diagnosis or treatment as

the Secretary considers appropriate.
Sec. 105 GULF WAR HEALTH ISSUES 182

(5) In each year after the implementation of the protocol, the

Secretary shall enter into an agreement with the National Academy of Sciences under which agreement appropriate experts shall

review the adequacy of the protocol and its implementation by the

Department of Veterans Affairs.

(b) RELATIONSHIP TO OTHER COMPREHENSIVE CLINICAL EVAL- UATION PROTOCOLS.—The Secretary, in consultation with the Secretary of Defense, shall ensure that the information collected

through the protocol described in this section is collected and maintained in a manner that permits the effective and efficient crossreference of that information with information collected and maintained through the comprehensive clinical protocols of the Department of Defense for Persian Gulf War veterans.

(c) CASE DEFINITIONS AND DIAGNOSES.—The Secretary shall

develop case definitions or diagnoses for illnesses associated with

the service described in subsection (a)(1). The Secretary shall develop such definitions or diagnoses at the earliest possible date.

SEC. 105. ø38 U.S.C. 1117 note¿ OUTREACH TO PERSIAN GULF

VETERANS.

(a) IN GENERAL.—The Secretary of Veterans Affairs shall implement a comprehensive outreach program to inform Persian Gulf

War veterans and their families of the medical care and other benefits that may be provided by the Department of Veterans Affairs

and the Department of Defense arising from service in the Persian

Gulf War.

(b) NEWSLETTER.—(1) The outreach program shall include a

newsletter which shall be updated and distributed at least semi-annually and shall be distributed to the veterans listed on the Persian Gulf War Veterans Health Registry. The newsletter shall include summaries of the status and findings of Government sponsored research on illnesses of Persian Gulf War veterans and their

families, as well as on benefits available to such individuals

through the Department of Veterans Affairs. The newsletter shall

be prepared in consultation with veterans service organizations.

(2) The requirement under this subsection for the distribution

of the newsletter shall terminate on December 31, 2003.

(c) TOLL-FREE NUMBER.—The outreach program shall include

establishment of a toll-free telephone number to provide Persian

Gulf War veterans and their families information on the Persian

Gulf War Veterans Health Registry, health care and other benefits

provided by the Department of Veterans Affairs, and such other information as the Secretary considers appropriate. Such toll-free

telephone number shall be established not later than 90 days after

the date of the enactment of this Act.

SEC. 106. COMPENSATION BENEFITS FOR DISABILITY RESULTING

FROM ILLNESS ATTRIBUTED TO SERVICE DURING THE

PERSIAN GULF WAR.

[Omitted—Amendments]

SEC. 107. ø38 U.S.C. 1117 note¿ EVALUATION OF HEALTH STATUS OF

SPOUSES AND CHILDREN OF PERSIAN GULF WAR VETERANS.

(a) EVALUATION PROGRAM.—Subject to subsection (c), the Secretary of Veterans Affairs shall conduct a program to evaluate the

health status of spouses and children of Persian Gulf War veterans.

Under the program, the Secretary shall provide for the conduct of
183 Sec. 107 GULF WAR HEALTH ISSUES

diagnostic testing and appropriate medical examinations of any

individual—

(1) who is the spouse or child of a veteran who—

(A) is listed in the Persian Gulf War Veterans Registry

established under section 702 of Public Law 102–585; and

(B) is suffering from an illness or disorder;

(2) who is apparently suffering from, or may have suffered

from, an illness or disorder (including a birth defect, miscarriage, or stillbirth) which cannot be disassociated from the

veteran’s service in the Southwest Asia theater of operations;

and

(3) who, in the case of a spouse, has granted the Secretary

permission to include in the Registry relevant medical data (including a medical history and the results of diagnostic testing

and medical examinations) and such other information as the

Secretary considers relevant and appropriate with respect to

such individual.

(b) DURATION OF PROGRAM.—The program shall be carried out

during the period beginning on November 1, 1994, and ending on

September 30, 2003.

(c) FUNDING LIMITATION.—The amount spent for the program under subsection (a) may not exceed $2,000,000.

(d) CONTRACTING.—The Secretary may provide for the conduct

of testing and examinations under subsection (a) through appropriate contract arrangements, including fee arrangements described in section 1703 of title 38, United States Code.

(e) STANDARD PROTOCOLS AND GUIDELINES.—The Secretary

shall seek to ensure uniform development of medical data through

the development of standard protocols and guidelines for such testing and examinations. If such protocols and guidelines have not

been adopted before the end of the 120-day period beginning on the

date of the enactment of this Act, the Secretary shall, before the

end of such period, submit to the Committees on Veterans’ Affairs

of the Senate and House of Representatives a report as to why such

protocols and guidelines have not yet been developed.

(f) ENTRY OF RESULTS IN REGISTRY.—The results of diagnostic

tests, medical histories, and medical examinations conducted under

subsection (a) shall be entered into the Persian Gulf War Veterans

Health Registry.

(g) OUTREACH.—The Secretary shall conduct such outreach activities as the Secretary determines necessary for the purposes of

the program. In conducting such outreach activities, the Secretary

shall advise that medical treatment is not available under the program.

(h) USE OUTSIDE DEPARTMENT OF STANDARD PROTOCOLS AND

GUIDELINES.—The Secretary shall—

(1) make the standard protocols and guidelines developed

under this section available to any entity which requests a

copy of such protocols and guidelines; and

(2) enter into the registry the results of any examination

of the spouse or child of a veteran who served in the Persian

Gulf theater which a licensed physician certifies was conducted

using those standard protocols and guidelines.

(i) REPORT TO CONGRESS.—Not later than July 31, 1999, the

Secretary shall submit to the Committees on Veterans’ Affairs of
Sec. 109 GULF WAR HEALTH ISSUES 184

the Senate and House of Representatives a report on activities with

respect to the program, including the provision of services under

subsection (d).

(j) DEFINITIONS.—For purposes of this section, the terms

‘‘child’’ and ‘‘spouse’’ have the meanings given those terms in paragraphs (4) and (31), respectively, of section 101 of title 38, United

States Code.

SEC. 108. CLARIFICATION OF SCOPE OF HEALTH EXAMINATIONS PROVIDED FOR VETERANS ELIGIBLE FOR INCLUSION IN

HEALTH-RELATED REGISTRIES.

[Omitted—Amendments]

SEC. 109. ø38 U.S.C. 1117 note¿ SURVEY OF PERSIAN GULF VETERANS.

(a) IN GENERAL.—The Secretary of Veterans Affairs may carry

out a survey of Persian Gulf veterans to gather information on the

incidence and nature of health problems occurring in Persian Gulf

veterans and their families.

(b) COORDINATION WITH DEPARTMENT OF DEFENSE.—Any survey under subsection (a) shall be carried out in coordination with

the Secretary of Defense.

(c) PERSIAN GULF VETERAN.—For purposes of this section, a

Persian Gulf veteran is an individual who served on active duty in

the Armed Forces in the Southwest Asia theater of operations during the Persian Gulf War as defined in section 101(33) of title 38,

United States Code.

SEC. 110. ø38 U.S.C. 1117 note¿ AUTHORIZATION FOR EPIDEMIOLOGICAL STUDIES.

(a) STUDY OF HEALTH CONSEQUENCES OF PERSIAN GULF SERVICE.—If the National Academy of Sciences includes in the report required by section 706(b) of the Veterans Health Care Act of 1992

(Public Law 102–585) a finding that there is a sound basis for an

epidemiological study or studies on the health consequences of

service in the Persian Gulf theater of operations during the Persian

Gulf War and recommends the conduct of such a study or studies,

the Secretary of Veterans Affairs is authorized to carry out such

study.

(b) OVERSIGHT.—(1) The Secretary shall seek to enter into an

agreement with the Medical Follow-Up Agency (MFUA) of the Institute of Medicine of the National Academy of Sciences for (A) the

review of proposals to conduct the research referred to in subsection (a), (B) oversight of such research, and (C) review of the research findings.

(2) If the Secretary is unable to enter into an agreement under

paragraph (1) with the entity specified in that paragraph, the Secretary shall enter into an agreement described in that paragraph

with another appropriate scientific organization which does not

have a connection to the Department of Veterans Affairs. In such

a case, the Secretary shall submit to the Committees on Veterans’

Affairs of the Senate and House of Representatives, at least 90

days before the date on which the agreement is entered into, notice

in writing identifying the organization with which the Secretary intends to enter into the agreement.

(c) ACCESS TO DATA.—The Secretary shall enter into agreements with the Secretary of Defense and the Secretary of Health

and Human Services to make available for the purposes of any
185 Sec. 110 GULF WAR HEALTH ISSUES

study described in subsection (a) all data that the Secretary, in

consultation with the National Academy of Sciences and the contractor for the study, considers relevant to the study.

(d) AUTHORIZATION.—There are authorized to be appropriated

to the Department such sums as are necessary for the conduct of

studies described in subsection (a).

SEC. 111. COST-SAVINGS PROVISIONS.

[Omitted—Amendments]
186

PERSIAN GULF WAR VETERANS’ HEALTH STATUS ACT

(Title VII of Public Law 102–585, approved Nov. 4, 1992)

TITLE VII—PERSIAN GULF WAR VETERANS’ HEALTH

STATUS

SEC. 701. ø38 U.S.C. 527 note¿ SHORT TITLE.

This title may be cited as the ‘‘Persian Gulf War Veterans’

Health Status Act’’.

SEC. 702. ø38 U.S.C. 527 note¿ PERSIAN GULF WAR VETERANS HEALTH

REGISTRY.

(a) ESTABLISHMENT OF REGISTRY.—The Secretary of Veterans

Affairs shall establish and maintain a special record to be known

as the ‘‘Persian Gulf War Veterans Health Registry’’ (in this section

referred to as the ‘‘Registry’’).

(b) CONTENTS OF REGISTRY.—Except as provided in subsection

(c), the Registry shall include the following information:

(1) A list containing the name of each individual who

served as a member of the Armed Forces in the Persian Gulf

theater of operations during the Persian Gulf War and who—

(A) applies for care or services from the Department of

Veterans Affairs under chapter 17 of title 38, United

States Code;

(B) files a claim for compensation under chapter 11 of

such title on the basis of any disability which may be associated with such service;

(C) dies and is survived by a spouse, child, or parent

who files a claim for dependency and indemnity compensation under chapter 13 of such title on the basis of such

service;

(D) requests from the Department a health examination under section 703; or

(E) receives from the Department of Defense a health

examination similar to the health examination referred to

in subparagraph (D) and requests inclusion in the

Registry.

(2) Relevant medical data relating to the health status of,

and other information that the Secretary considers relevant

and appropriate with respect to, each individual described in

paragraph (1) who—

(A) grants to the Secretary permission to include such

information in the Registry; or

(B) at the time the individual is listed in the Registry,

is deceased.

(c) INDIVIDUALS SUBMITTING CLAIMS OR MAKING REQUESTS BE- FORE DATE OF ENACTMENT.—If in the case of an individual described in subsection (b)(1) the application, claim, or request re-
187 Sec. 703 GULF WAR HEALTH ISSUES

ferred to in such subsection was submitted, filed, or made, before

the date of the enactment of this Act, the Secretary shall, to the

extent feasible, include in the Registry such individual’s name and

the data and information, if any, described in subsection (b)(2) relating to the individual.

(d) DEPARTMENT OF DEFENSE INFORMATION.—The Secretary of

Defense shall furnish to the Secretary of Veterans Affairs such information maintained by the Department of Defense as the Secretary of Veterans Affairs considers necessary to establish and

maintain the Registry.

(e) RELATION TO DEPARTMENT OF DEFENSE REGISTRY.—The

Secretary of Veterans Affairs, in consultation with the Secretary of

Defense, shall ensure that information is collected and maintained

in the Registry in a manner that permits effective and efficient

cross-reference between the Registry and the registry established

under section 734 of the National Defense Authorization Act for

Fiscal Years 1992 and 1993 (Public Law 102–190; 105 Stat. 1411;

10 U.S.C. 1074 note), as amended by section 704.

(f) ONGOING OUTREACH TO INDIVIDUALS LISTED IN REGISTRY.—

The Secretary of Veterans Affairs shall, from time to time, notify

individuals listed in the Registry of significant developments in research on the health consequences of military service in the Persian Gulf theater of operations during the Persian Gulf War.

SEC. 703. ø38 U.S.C. 527 note¿ HEALTH EXAMINATIONS AND COUNSELING FOR VETERANS ELIGIBLE FOR INCLUSION IN

CERTAIN HEALTH-RELATED REGISTRIES.

(a) IN GENERAL.—(1) The Secretary of Veterans Affairs—

(A) shall, upon the request of a veteran described in subsection (b)(1), provide the veteran with a health examination

(including any appropriate diagnostic tests) and consultation

and counseling with respect to the results of the examination

and the tests; and

(B) may, upon the request of a veteran described in subsection (b)(2), provide the veteran with such an examination

(including diagnostic tests) and such consultation and counseling.

(2) The Secretary shall carry out appropriate outreach activities with respect to the provision of any health examinations (including any diagnostic tests) and consultation and counseling services under paragraph (1).

(b) COVERED VETERANS.—(1) In accordance with subsection

(a)(1)(A), the Secretary shall provide an examination (including diagnostic tests), consultation, and counseling under that subsection

to any veteran who is eligible for listing or inclusion in the Persian

Gulf War Veterans Health Registry established by section 702.

(2) In accordance with subsection (a)(1)(B), the Secretary may

provide an examination (including diagnostic tests), consultation,

and counseling under that subsection to any veteran who is eligible

for listing or inclusion in any other similar health-related registry

administered by the Secretary.

* * * * * * *
Sec. 706 GULF WAR HEALTH ISSUES 188

SEC. 706. ø38 U.S.C. 527 note¿ AGREEMENT WITH NATIONAL ACADEMY

OF SCIENCES FOR REVIEW OF HEALTH CONSEQUENCES

OF SERVICE DURING THE PERSIAN GULF WAR.

(a) AGREEMENT.—(1) The Secretary of Veterans Affairs and

Secretary of Defense jointly shall seek to enter into an agreement

with the National Academy of Sciences for the Medical Follow-Up

Agency (MFUA) of the Institute of Medicine of the Academy to review existing scientific, medical, and other information on the

health consequences of military service in the Persian Gulf theater

of operations during the Persian Gulf War.

(2) The agreement shall require MFUA to provide members of

veterans organizations and members of the scientific community

(including the Director of the Office of Technology Assessment)

with the opportunity to comment on the method or methods MFUA

proposes to use in conducting the review.

(3) The agreement shall permit MFUA, in conducting the review, to examine and evaluate medical records of individuals who

are included in the registries referred to in section 705(d) for purposes that MFUA considers appropriate, including the purpose of

identifying illnesses of those individuals.

(4) The Secretary of Veterans Affairs and the Secretary of Defense shall seek to enter into the agreement under this section not

later than 180 days after the date of the enactment of this Act.

(b) REPORT.—(1) The agreement under this section shall require the National Academy of Sciences to submit to the committees and secretaries referred to in paragraph (2) a report on the results of the review carried out under the agreement. Such report

shall contain the following:

(A) An assessment of the effectiveness of actions taken by

the Secretary of Veterans Affairs and the Secretary of Defense

to collect and maintain information that is potentially useful

for assessing the health consequences of the military service

referred to in subsection (a).

(B) Recommendations on means of improving the collection

and maintenance of such information.

(C) Recommendations on whether there is sound scientific

basis for an epidemiological study or studies on the health consequences of such service, and if the recommendation is that

there is sound scientific basis for such a study or studies, the

nature of the study or studies.

(2) The committees and secretaries referred to in paragraph (1)

are the following:

(A) The Committees on Veterans’ Affairs of the Senate and

House of Representatives.

(B) The Committees on Armed Services of the Senate and

House of Representatives.

(C) The Secretary of Veterans Affairs.

(D) The Secretary of Defense.

(c) FUNDING.—(1) The Secretary of Veterans Affairs and the

Secretary of Defense shall make available up to a total of $500,000

in fiscal year 1993, from funds available to the Department of Veterans Affairs and the Department of Defense in that fiscal year, to

carry out the review. Any amounts provided by the two departments shall be provided in equal amounts.
189 Sec. 707 GULF WAR HEALTH ISSUES

(2) If the Secretary of Veterans Affairs and the Secretary of

Defense enter into an agreement under subsection (a) with the National Academy of Sciences—

(A) the Secretary of Veterans Affairs shall make available $250,000 in each of fiscal years 1994 through 2003, from

amounts available to the Department of Veterans Affairs in

each such fiscal year, to the National Academy of Sciences for

the general purposes of conducting epidemiological research

with respect to military and veterans populations; and (B) the Secretary of Defense shall make available $250,000

in each of fiscal years 1994 through 2003, from amounts available to the Department of Defense in each such fiscal year, to

the National Academy of Sciences for the purposes of carrying

out the research referred to in subparagraph (A).

(d) RESEARCH REVIEW AND DEVELOPMENT OF MEDICAL

EDUCATION CURRICULUM.—(1) In order to further understand the

health consequences of military service in the Persian Gulf theater

of operations during the Persian Gulf War and of new research

findings with implications for improving the provision of care for

veterans of such service, the Secretary of Veterans Affairs and the

Secretary of Defense shall seek to enter into an agreement with the

National Academy of Sciences under which the Institute of Medicine of the Academy would—

(A) develop a curriculum pertaining to the care and treatment of veterans of such service who have ill-defined or

undiagnosed illnesses for use in the continuing medical education of both general and specialty physicians who provide

care for such veterans; and

(B) on an ongoing basis, periodically review and provide

recommendations regarding the research plans and research

strategies of the Departments relating to the health consequences of military service in the Persian Gulf theater of operations during the Persian Gulf War.

(2) Recommendations to be provided under paragraph (1)(B) include any recommendations that the Academy considers appropriate for additional scientific studies (including studies related to

treatment models) to resolve areas of continuing scientific uncertainty relating to the health consequences of any aspects of such

military service. In making recommendations for additional studies, the Academy shall consider the available scientific data, the

value and relevance of the information that could result from such

studies, and the cost and feasibility of carrying out such studies.

(3) Not later than 9 months after the Institute of Medicine provides the Secretaries the curriculum developed under paragraph

(1)(A), the Secretaries shall provide for the conduct of continuing

education programs using that curriculum. Those programs shall

include instruction which seeks to emphasize use of appropriate

protocols of diagnosis, referral, and treatment of such veterans.

SEC. 707. ø38 U.S.C. 527 note¿ COORDINATION OF HEALTH-RELATED

GOVERNMENT ACTIVITIES ON THE PERSIAN GULF WAR.

(a) DESIGNATION OF COORDINATING ORGANIZATION.—The President shall designate, and may redesignate from time to time, the

head of an appropriate department or agency of the Federal Government to coordinate all activities undertaken or funded by the
Sec. 707 GULF WAR HEALTH ISSUES 190

Executive Branch of the Federal Government on the health consequences of military service in the Persian Gulf theater of operations during the Persian Gulf War.

(b) PUBLIC ADVISORY COMMITTEE.—Not later than January 1,

1999, the head of the department or agency designated under subsection (a) shall establish an advisory committee consisting of

members of the general public, including Persian Gulf War veterans and representatives of such veterans, to provide advice to the

head of that department or agency on proposed research studies,

research plans, or research strategies relating to the health consequences of military service in the Southwest Asia theater of operations during the Persian Gulf War. The department or agency

head shall consult with such advisory committee on a regular basis.

(c) REPORTS.—(1) Not later than March 1 of each year, the

head of the department or agency designated under subsection (a)

shall submit to the Committees on Veterans’ Affairs of the Senate

and House of Representatives a report on—

(A) the status and results of all such research activities

undertaken by the executive branch during the previous year;

and

(B) research priorities identified during that year.

(2)(A) Not later than 120 days after submission of the epidemiological research study conducted by the Department of Veterans

Affairs entitled ‘‘VA National Survey of Persian Gulf Veterans—

Phase III’’, the head of the department or agency designated under

subsection (a) shall submit to the congressional committees specified in paragraph (1) a report on the findings under that study and

any other pertinent medical literature.

(B) With respect to any findings of that study and any other

pertinent medical literature which identify scientific evidence of a

greater relative risk of illness or illnesses in family members of veterans who served in the Persian Gulf War theater of operations

than in family members of veterans who did not so serve, the head

of the department or agency designated under subsection (a) shall

seek to ensure that appropriate research studies are designed to

follow up on such findings.

(d) PUBLIC AVAILABILITY OF RESEARCH FINDINGS.—The head of

the department or agency designated under subsection (a) shall ensure that the findings of all research conducted by or for the executive branch relating to the health consequences of military service

in the Persian Gulf theater of operations during the Persian Gulf

War (including information pertinent to improving provision of care

for veterans of such service) are made available to the public

through peer-reviewed medical journals, the World Wide Web, and

other appropriate media.

(e) OUTREACH.—The head of the department or agency

designated under subsection (a) shall ensure that the appropriate

departments consult and coordinate in carrying out an ongoing program to provide information to those who served in the Southwest

Asia theater of operations during the Persian Gulf War relating to:

(1) the health risks, if any, resulting from any risk factors associated with such service; and (2) any services or benefits available

with respect to such health risks.
191 Sec. 708 GULF WAR HEALTH ISSUES

SEC. 708. ø38 U.S.C. 527 note¿ DEFINITION.

For the purposes of this title, the term ‘‘Persian Gulf War’’ has

the meaning given such term in section 101(33) of title 38, United

States Code.
192

HEALTH CARE SHARING AGREEMENTS BETWEEN DEPARTMENT OF DEFENSE AND DEPARTMENT OF VETERANS AFFAIRS

SECTIONS 8111 AND 8111A OF TITLE 38, UNITED STATES

CODE

§ 8111. Sharing of Department of Veterans Affairs and Department of Defense health care resources

(a) REQUIRED COORDINATION AND SHARING OF HEALTH CARE

RESOURCES.—The Secretary of Veterans Affairs and the Secretary

of Defense shall enter into agreements and contracts for the mutually beneficial coordination, use, or exchange of use of the health

care resources of the Department of Veterans Affairs and the Department of Defense with the goal of improving the access to, and

quality and cost effectiveness of, the health care provided by the

Veterans Health Administration and the Military Health System to

the beneficiaries of both Departments.

(b) JOINT REQUIREMENTS FOR SECRETARIES OF VETERANS AFFAIRS AND DEFENSE.—To facilitate the mutually beneficial coordination, use, or exchange of use of the health care resources of the

two Departments, the two Secretaries shall carry out the following

functions:

(1) Develop and publish a joint strategic vision statement

and a joint strategic plan to shape, focus, and prioritize the coordination and sharing efforts among appropriate elements of

the two Departments and incorporate the goals and requirements of the joint sharing plan into the strategic and performance plan of each Department under the Government Performance and Results Act.

(2) Jointly fund the interagency committee provided for

under subsection (c).

(3) Continue to facilitate and improve sharing between individual Department of Veterans Affairs and Department of

Defense health care facilities, but giving priority of effort to

initiatives (A) that improve sharing and coordination of health

resources at the intraregional and nationwide levels, and (B)

that improve the ability of both Departments to provide coordinated health care.

(4) Establish a joint incentive program under subsection

(d).

(c) DOD–VA HEALTH EXECUTIVE COMMITTEE.—(1) There is established an interagency committee to be known as the Department of Veterans Affairs-Department of Defense Health Executive
193 § 8111 HEALTH CARE SHARING AGREEMENTS

Committee (hereinafter in this section referred to as the ‘‘Committee’’). The Committee is composed of—

(A) the Deputy Secretary of Veterans Affairs and such

other officers and employees of the Department of Veterans Affairs as the Secretary of Veterans Affairs may designate; and

(B) the Under Secretary of Defense for Personnel and

Readiness and such other officers and employees of the Department of Defense as the Secretary of Defense may designate.

(2)(A) During odd-numbered fiscal years, the Deputy Secretary

of Veterans Affairs shall chair the Committee. During even-numbered fiscal years, the Under Secretary of Defense shall chair the

Committee.

(B) The Deputy Secretary and the Under Secretary shall determine the size and structure of the Committee, as well as the administrative and procedural guidelines for the operation of the

Committee. The two Departments shall share equally the Committee’s cost of personnel and administrative support and services.

Support for such purposes shall be provided at a level sufficient for

the efficient operation of the Committee, including a permanent

staff and, as required, other temporary working groups of appropriate departmental staff and outside experts.

(3) The Committee shall recommend to the Secretaries strategic direction for the joint coordination and sharing efforts between and within the two Departments under this section and

shall oversee implementation of those efforts.

(4) The Committee shall submit to the two Secretaries and to

Congress an annual report containing such recommendations as

the Committee considers appropriate.

(5) In order to enable the Committee to make recommendations

in its annual report under paragraph (4), the Committee shall do

the following:

(A) Review existing policies, procedures, and practices relating to the coordination and sharing of health care resources

between the two Departments.

(B) Identify changes in policies, procedures, and practices

that, in the judgment of the Committee, would promote mutually beneficial coordination, use, or exchange of use of the

health care resources of the two Departments, with the goal of

improving the access to, and quality and cost effectiveness of,

the health care provided by the Veterans Health Administration and the Military Health System to the beneficiaries of

both Departments.

(C) Identify and assess further opportunities for the coordination and sharing of health care resources between the Departments that, in the judgment of the Committee, would not

adversely affect the range of services, the quality of care, or

the established priorities for care provided by either Department.

(D) Review the plans of both Departments for the acquisition of additional health care resources, especially new facilities and major equipment and technology, in order to assess

the potential effect of such plans on further opportunities for

the coordination and sharing of health care resources.
§ 8111 HEALTH CARE SHARING AGREEMENTS 194

(E) Review the implementation of activities designed to

promote the coordination and sharing of health care resources

between the Departments.

(6) The Committee chairman, under procedures jointly developed by the two Secretaries, may require the Inspector General of

either or both Departments to assist in activities under paragraph

(5)(E).

(d) JOINT INCENTIVES PROGRAM.—(1) Pursuant to subsection

(b)(4), the two Secretaries shall carry out a program to identify,

provide incentives to, implement, fund, and evaluate creative coordination and sharing initiatives at the facility, intraregional, and

nationwide levels. The program shall be administered by the Committee established in subsection (c), under procedures jointly prescribed by the two Secretaries.

(2) To facilitate the incentive program, effective October 1,

2003, there is established in the Treasury a fund to be known as

the ‘‘DOD–VA Health Care Sharing Incentive Fund’’. Each Secretary shall annually contribute to the fund a minimum of

$15,000,000 from the funds appropriated to that Secretary’s Department. Such funds shall remain available until expended.

(3)(A) For each fiscal year during which the program under

this subsection is in effect, the Comptroller General shall conduct

a review of the implementation and effectiveness of the incentives

program under this subsection. Upon completion of each such annual review, the Comptroller General shall submit to the Committees on Armed Services and Veterans’ Affairs of the Senate and

House of Representatives a report on the results of that review.

Each such report shall be submitted not later than February 28 of

the year following the fiscal year covered by the report. In addition,

the Comptroller General shall conduct such a review during the

first five months of fiscal year 2004 and, not later than February

28, 2004, shall submit to those committees a report on the implementation and effectiveness of the incentives program under this

subsection to that date.

(B) Each report under this paragraph shall describe activities

carried out under the program under this subsection during the

preceding fiscal year (or, in the case of the first such report, to the

date of the submission of the report). Each report shall include at

least the following:

(i) An analysis of the initiatives funded by the Committee,

and the funds so expended by such initiatives, from the DODVA Health Care Sharing Incentive Fund, including the purposes and effects of those initiatives on improving access to

care by beneficiaries, improvements in the quality of care received by those beneficiaries, and efficiencies gained in delivering services to those beneficiaries.

(ii) Other matters of interest, including recommendations

from the Comptroller General for legislative improvements to

the program.

(4) The program under this subsection shall terminate on September 30, 2007.

(e) GUIDELINES AND POLICIES FOR IMPLEMENTATION OF COORDI- NATION AND SHARING RECOMMENDATIONS, CONTRACTS, AND AGREEMENTS.—(1) To implement the recommendations made by the Com-
195 § 8111 HEALTH CARE SHARING AGREEMENTS

mittee under subsection (c)(2), as well as to carry out other health

care contracts and agreements for coordination and sharing initiatives as they consider appropriate, the two Secretaries shall jointly

issue guidelines and policy directives. Such guidelines and policies

shall provide for coordination and sharing that—

(A) is consistent with the health care responsibilities of the

Department of Veterans Affairs under this title and with the

health care responsibilities of the Department of Defense

under chapter 55 of title 10;

(B) will not adversely affect the range of services, the quality of care, or the established priorities for care provided by either Department; and

(C) will not reduce capacities in certain specialized programs of the Department of Veterans Affairs that the Secretary is required to maintain in accordance with section

1706(b) of this title.

(2) To facilitate the sharing and coordination of health care

services between the two Departments, the two Secretaries shall

jointly develop and implement guidelines for a standardized, uniform payment and reimbursement schedule for those services. Such

schedule shall be implemented no later than October 1, 2003, and

shall be revised periodically as necessary. The two Secretaries, following implementation of the schedule, may on a case-by-case basis

waive elements of the schedule if they jointly agree that such a

waiver is in the best interests of both Departments.

(3)(A) The guidelines established under paragraph (1) shall authorize the heads of individual Department of Defense and Department of Veterans Affairs medical facilities and service regions to

enter into health care resources coordination and sharing agreements.

(B) Under any such agreement, an individual who is a primary

beneficiary of one Department may be provided health care, as provided in the agreement, at a facility or in the service region of the

other Department that is a party to the sharing agreement.

(C) Each such agreement shall identify the health care resources to be shared.

(D) Each such agreement shall provide, and shall specify procedures designed to ensure, that the availability of direct health care

to individuals who are not primary beneficiaries of the providing

Department is (i) on a referral basis from the facility or service region of the other Department, and (ii) does not (as determined by

the head of the providing facility or region) adversely affect the

range of services, the quality of care, or the established priorities

for care provided to the primary beneficiaries of the providing Department.

(E) Each such agreement shall provide that a providing Department or service region shall be reimbursed for the cost of the

health care resources provided under the agreement and that the

rate of such reimbursement shall be as determined in accordance

with paragraph (2).

(F) Each proposal for an agreement under this paragraph shall

be effective (i) on the 46th day after the receipt of such proposal

by the Committee, unless earlier disapproved, or (ii) if earlier approved by the Committee, on the date of such approval.
§ 8111 HEALTH CARE SHARING AGREEMENTS 196

(G) Any funds received through such a uniform payment and

reimbursement schedule shall be credited to funds that have been

allotted to the facility of either Department that provided the care

or services, or is due the funds from, any such agreement.

(f) ANNUAL JOINT REPORT.—(1) At the time the President’s

budget is transmitted to Congress in any year pursuant to section

1105 of title 31, the two Secretaries shall submit to Congress a

joint report on health care coordination and sharing activities

under this section during the fiscal year that ended during the previous calendar year.

(2) Each report under this section shall include the following:

(A) The guidelines prescribed under subsection (e) (and

any revision of such guidelines).

(B) The assessment of further opportunities identified

under subparagraph (C) of subsection (c)(5) for the sharing of

health-care resources between the two Departments.

(C) Any recommendation made under subsection (c)(4) during such fiscal year.

(D) A review of the sharing agreements entered into under

subsection (e) and a summary of activities under such agreements during such fiscal year and a description of the results

of such agreements in improving access to, and the quality and

cost effectiveness of, the health care provided by the Veterans

Health Administration and the Military Health System to the

beneficiaries of both Departments.

(E) A summary of other planning and activities involving

either Department in connection with promoting the coordination and sharing of Federal health-care resources during the

preceding fiscal year.

(F) Such recommendations for legislation as the two Secretaries consider appropriate to facilitate the sharing of healthcare resources between the two Departments.

(3) In addition to the matters specified in paragraph (2), the

two Secretaries shall include in the annual report under this subsection an overall status report of the progress of health resources

sharing between the two Departments as a consequence of subtitle

C of title VII of the Bob Stump National Defense Authorization Act

for Fiscal Year 2003 and of other sharing initiatives taken during

the period covered by the report. Such status report shall indicate

the status of such sharing and shall include appropriate data as

well as analyses of that data. The annual report shall include the

following:

(A) Enumerations and explanations of major policy decisions reached by the two Secretaries during the period covered

by the report period with respect to sharing between the two

Departments.

(B) A description of progress made in new ventures or particular areas of sharing and coordination that would be of policy interest to Congress consistent with the intent of such subtitle.

(C) A description of enhancements of access to care of

beneficiaries of both Departments that came about as a result

of new sharing approaches brought about by such subtitle.
197 § 8111 HEALTH CARE SHARING AGREEMENTS

(D) A description of proposals for which funds are provided

through the joint incentives program under subsection (d), together with a description of their results or status at the time

of the report, including access improvements, savings, and

quality-of-care enhancements they brought about, and a description of any additional use of funds made available under

subsection (d).

(4) In addition to the matters specified in paragraphs (2) and

(3), the two Secretaries shall include in the annual report under

this subsection for each year through 2008 the following:

(A) A description of the measures taken, or planned to be

taken, to implement the health resources sharing project under

section 722 of the Bob Stump National Defense Authorization

Act for Fiscal Year 2003 and any cost savings anticipated, or

cost sharing achieved, at facilities participating in the project,

including information on improvements in access to care, quality, and timeliness, as well as impediments encountered and

legislative recommendations to ameliorate such impediments.

(B) A description of the use of the waiver authority provided by section 722(d)(1) of the Bob Stump National Defense

Authorization Act for Fiscal Year 2003, including—

(i) a statement of the numbers and types of requests

for waivers under that section of administrative policies

that have been made during the period covered by the report and, for each such request, an explanation of the content of each request, the intended purpose or result of the

requested waiver, and the disposition of each request; and

(ii) descriptions of any new administrative policies

that enhance the success of the project.

(5) In addition to the matters specified in paragraphs (2), (3),

and (4), the two Secretaries shall include in the annual report

under this subsection for each year through 2009 a report on the

pilot program for graduate medical education under section 725 of

the Bob Stump National Defense Authorization Act for Fiscal Year

2003, including activities under the program during the preceding

year and each Secretary’s assessment of the efficacy of providing

education and training under that program.

(g) DEFINITIONS.—For the purposes of this section:

(1) The term ‘‘beneficiary’’ means a person who is a primary beneficiary of the Department of Veterans Affairs or of

the Department of Defense.

(2) The term ‘‘direct health care’’ means health care provided to a beneficiary in a medical facility operated by the Department of Veterans Affairs or the Department of Defense.

(3) The term ‘‘head of a medical facility’’ (A) with respect

to a medical facility of the Department of Veterans Affairs,

means the director of the facility, and (B) with respect to a

medical facility of the Department of Defense, means the medical or dental officer in charge or the contract surgeon in

charge.

(4) The term ‘‘health-care resource’’ includes hospital care,

medical services, and rehabilitative services, as those terms

are defined in paragraphs (5), (6), and (8), respectively, of section 1701 of this title, services under sections 1782 and 1783
§ 8111A HEALTH CARE SHARING AGREEMENTS 198

of this title, any other health-care service, and any health-care

support or administrative resource.

(5) The term ‘‘primary beneficiary’’ (A) with respect to the

Department means a person who is eligible under this title

(other than under section 1782, 1783, or 1784 or subsection (d)

of this section) or any other provision of law for care or services

in Department medical facilities, and (B) with respect to the

Department of Defense, means a member or former member of

the Armed Forces who is eligible for care under section 1074

of title 10.

(6) The term ‘‘providing Department’’ means the Department of Veterans Affairs, in the case of care or services furnished by a facility of the Department of Veterans Affairs, and

the Department of Defense, in the case of care or services furnished by a facility of the Department of Defense.

(7) The term ‘‘service region’’ means a geographic service

area of the Veterans Health Administration, in the case of the

Department of Veterans Affairs, and a service region, in the

case of the Department of Defense.

§ 8111A. Furnishing of health-care services to members of

the Armed Forces during a war or national emergency

(a)(1) During and immediately following a period of war, or a

period of national emergency declared by the President or the Congress that involves the use of the Armed Forces in armed conflict,

the Secretary may furnish hospital care, nursing home care, and

medical services to members of the Armed Forces on active duty.

(2)(A) During and immediately following a disaster or emergency referred to in subparagraph (B), the Secretary may furnish

hospital care and medical services to members of the Armed Forces

on active duty responding to or involved in that disaster or emergency.

(B) A disaster or emergency referred to in this subparagraph

is any disaster or emergency as follows:

(i) A major disaster or emergency declared by the President under the Robert B. Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C. 5121 et seq.).

(ii) A disaster or emergency in which the National Disaster

Medical System established pursuant to section 2811(b) of the

Public Health Service Act (42 U.S.C. 300hh–11(b)) is activated

by the Secretary of Health and Human Services under paragraph (3)(A) of that section or as otherwise authorized by law.

(3) The Secretary may give a higher priority to the furnishing

of care and services under this section than to the furnishing of

care and services to any other group of persons eligible for care and

services in medical facilities of the Department with the exception

of veterans with service-connected disabilities.

(4) For the purposes of this section, the terms ‘‘hospital care’’,

‘‘nursing home care’’, and ‘‘medical services’’ have the meanings

given such terms by sections 1701(5), 101(28), and 1701(6) of this

title, respectively, and the term ‘‘medical services’’ includes services

under sections 1782 and 1783 of this title.
199 § 8111A HEALTH CARE SHARING AGREEMENTS

(b)(1) During a period in which the Secretary is authorized to

furnish care and services to members of the Armed Forces under

subsection (a) of this section, the Secretary, to the extent authorized by the President and subject to the availability of appropriations or reimbursements under subsection (c) of this section, may

enter into contracts with private facilities for the provision during

such period by such facilities of hospital care and medical services

described in paragraph (2) of this subsection.

(2) Hospital care and medical services referred to in paragraph

(1) of this subsection are—

(A) hospital care and medical services authorized under

this title for a veteran and necessary for the care or treatment

of a condition for which the veteran is receiving medical services at a Department facility under subsection (a) of section

1710 of this title, in a case in which the delay involved in furnishing such care or services at such Department facility or at

any other Department facility reasonably accessible to the veteran would, in the judgment of the Under Secretary for Health,

be likely to result in a deterioration of such condition; and

(B) hospital care for a veteran who—

(i) is receiving hospital care under section 1710 of this

title; or

(ii) is eligible for hospital care under such section and

requires such care in a medical emergency that poses a serious threat to the life or health of the veteran;

if Department facilities are not capable of furnishing or continuing to furnish the care required because of the furnishing

of care and services to members of the Armed Forces under

subsection (a) of this section.

(c)(1) The cost of any care or services provided by the Department under subsection (a) of this section shall be reimbursed to the

Department by the Department of Defense at such rates as may be

agreed upon by the Secretary and the Secretary of Defense based

on the cost of the care or services provided.

(2) Amounts received under this subsection shall be credited to

funds allotted to the Department facility that provided the care or

services.

(d)(1) The Secretary and the Secretary of Defense shall jointly

review plans for the implementation of this section not less often

than annually.

(2) Whenever a modification to such plans is agreed to, the

Secretaries shall jointly submit to the Committees on Veterans’ Affairs of the Senate and House of Representatives a report on such

modification. Any such report shall be submitted within 30 days

after the modification is agreed to.

(e) The Secretary shall prescribe regulations to govern any exercise of the authority of the Secretary under subsections (a) and

(b) of this section and of the Under Secretary for Health under subsection (b)(2)(A) of this section.
Sec. 113 HEALTH CARE SHARING AGREEMENTS 200

SECTION 113 OF THE VETERANS MILLENNIUM HEALTH

CARE AND BENEFITS ACT

(Public Law 106–117, approved Nov. 30, 1999)

SEC. 113. ø38 U.S.C. 8111 note¿ ACCESS TO CARE FOR TRICARE-ELIGIBLE MILITARY RETIREES.

(a) INTERAGENCY AGREEMENT.—(1) The Secretary of Defense

shall enter into an agreement (characterized as a memorandum of

understanding or otherwise) with the Secretary of Veterans Affairs

with respect to the provision of medical care by the Secretary of

Veterans Affairs to eligible military retirees in accordance with the

provisions of subsection (c). That agreement shall include provisions for reimbursement of the Secretary of Veterans Affairs by the

Secretary of Defense for medical care provided by the Secretary of

Veterans Affairs to an eligible military retiree and may include

such other provisions with respect to the terms and conditions of

such care as may be agreed upon by the two Secretaries.

(2) Reimbursement under the agreement under paragraph (1)

shall be in accordance with rates agreed upon by the Secretary of

Defense and the Secretary of Veterans Affairs. Such reimbursement may be made by the Secretary of Defense or by the appropriate TRICARE Managed Care Support contractor, as determined

in accordance with that agreement.

(3) In entering into the agreement under paragraph (1), particularly with respect to determination of the rates of reimbursement under paragraph (2), the Secretary of Defense shall consult

with TRICARE Managed Care Support contractors.

(4) The Secretary of Veterans Affairs may not enter into an

agreement under paragraph (1) for the provision of care in accordance with the provisions of subsection (c) with respect to any geographic service area, or a part of any such area, of the Veterans

Health Administration unless—

(A) in the judgment of that Secretary, the Department of

Veterans Affairs will recover the costs of providing such care

to eligible military retirees; and

(B) that Secretary has certified and documented, with respect to any geographic service area in which the Secretary

proposes to provide care in accordance with the provisions of

subsection (c), that such geographic service area, or designated

part of any such area, has adequate capacity (consistent with

the requirements in section 1705(b)(1) of title 38, United States

Code, that care to enrollees shall be timely and acceptable in

quality) to provide such care.

(5) The agreement under paragraph (1) shall be entered into

by the Secretaries not later than nine months after the date of the

enactment of this Act. If the Secretaries are unable to reach agreement, they shall jointly report, by that date or within 30 days

thereafter, to the Committees on Armed Services and the Committees on Veterans’ Affairs of the Senate and House of Representatives on the reasons for their inability to reach an agreement and

their mutually agreed plan for removing any impediments to final

agreement.

(b) DEPOSITING OF REIMBURSEMENTS.—Amounts received by

the Secretary of Veterans Affairs under the agreement under sub-
201 Sec. 201 HEALTH CARE SHARING AGREEMENTS

section (a) shall be deposited in the Department of Veterans Affairs

Medical Care Collections Fund established under section 1729A of

title 38, United States Code.

(c) COPAYMENT REQUIREMENT.—The provisions of subsections

(f )(1) and (g)(1) of section 1710 of title 38, United States Code,

shall not apply in the case of an eligible military retiree who is covered by the agreement under subsection (a).

(d) PHASED IMPLEMENTATION.—(1) The Secretary of Defense

shall include in each TRICARE contract entered into after the date

of the enactment of this Act provisions to implement the agreement

under subsection (a).

(2) The provisions of the agreement under subsection (a)(2) and

the provisions of subsection (c) shall apply to the furnishing of

medical care by the Secretary of Veterans Affairs in any area of the

United States only if that area is covered by a TRICARE contract

that was entered into after the date of the enactment of this Act.

(e) ELIGIBLE MILITARY RETIREES.—For purposes of this section,

an eligible military retiree is a member of the Army, Navy, Air

Force, or Marine Corps who—

(1) has retired from active military, naval, or air service;

(2) is eligible for care under the TRICARE program established by the Secretary of Defense;

(3) has enrolled for care under section 1705 of title 38,

United States Code; and

(4) is not described in paragraph (1) or (2) of section

1710(a) of such title.

TITLE II OF THE VETERANS HEALTH CARE ACT OF 1992

(Public Law 102–585, approved Nov. 4, 1992)

TITLE II—HEALTH-CARE SHARING AGREEMENTS BETWEEN DEPARTMENT OF VETERANS AFFAIRS AND

DEPARTMENT OF DEFENSE

SEC. 201. ø38 U.S.C. 8111 note¿ TEMPORARY EXPANSION OF AUTHORITY

FOR SHARING AGREEMENTS.

(a) AUTHORITY.—The Secretary of Veterans Affairs may enter

into an agreement with the Secretary of Defense under this section

to expand the availability of health-care sharing arrangements

with the Department of Defense under section 8111(c) of title 38,

United States Code. Under such an agreement—

(1) the head of a Department of Veterans Affairs medical

facility may enter into agreements under section 8111(d) of

that title with (A) the head of a Department of Defense medical facility, (B) with any other official of the Department of

Defense responsible for the provision of care under chapter 55

of title 10, United States Code, to persons who are covered

beneficiaries under that chapter, in the region of the Department of Veterans Affairs medical facility, or (C) with a contractor of the Department of Defense responsible for the provision of care under chapter 55 of title 10, United States Code,

to persons who are covered beneficiaries under that chapter, in
Sec. 202 HEALTH CARE SHARING AGREEMENTS 202

the region of the Department of Veterans Affairs medical facility; and

(2) the term ‘‘primary beneficiary’’ shall be treated as

including—

(A) with respect to the Department of Veterans Affairs, any person who is described in section 1713 of title

38, United States Code; and

(B) with respect to the Department of Defense, any

person who is a covered beneficiary under chapter 55 of

title 10, United States Code.

(b) USE OF FUNDS.—Any amount received by the Secretary

from a non-Federal entity as payment for services provided by the

Secretary during a prior fiscal year under an agreement entered

into under this section may be obligated by the Secretary during

the fiscal year in which the Secretary receives the payment.

SEC. 202. ø38 U.S.C. 8111 note¿ REQUIREMENT FOR IMPROVEMENT IN

SERVICES FOR VETERANS.

A proposed agreement authorized by section 201 that is entered into by the head of a Department of Veterans Affairs medical

facility may take effect only if the Under Secretary for Health of

the Department of Veterans Affairs finds, and certifies to the Secretary of Veterans Affairs, that implementation of the agreement—

(1) will result in the improvement of services to eligible

veterans at that facility; and

(2) will not result in the denial of, or a delay in providing,

access to care for any veteran at that facility.

SEC. 203. ø38 U.S.C. 8111 note¿ EXPANDED SHARING AGREEMENTS

WITH DEPARTMENT OF DEFENSE.

Under an agreement under section 201, guidelines under section 8111(b) of title 38, United States Code, may be modified to

provide that, notwithstanding any other provision of law, any person who is a covered beneficiary under chapter 55 of title 10 and

who is furnished care or services by a facility of the Department

of Veterans Affairs under an agreement entered into under section

8111 of that title, or who is described in section 1713 of title 38,

United States Code, and who is furnished care or services by a facility of the Department of Defense, may be authorized to receive

such care or services—

(1) without regard to any otherwise applicable requirement

for the payment of a copayment or deductible; or

(2) subject to a requirement to pay only part of any such

otherwise applicable copayment or deductible, as specified in

the guidelines.

SEC. 204. ø38 U.S.C. 8111 note¿ EXPIRATION OF AUTHORITY.

[Repealed by section 302(b) of the Veterans’ Health Care Eligibility Reform Act of 1996 (Public Law 104–262).]

SEC. 205. ø38 U.S.C. 8111 note¿ CONSULTATION WITH VETERANS SERVICE ORGANIZATIONS.

In carrying out this title, the Secretary of Veterans Affairs

shall consult with organizations named in or approved under section 5902 of title 38, United States Code.
203 Sec. 207 HEALTH CARE SHARING AGREEMENTS

SEC. 206. ø38 U.S.C. 8111 note¿ ANNUAL REPORT.

[Omitted-Obsolete]

(a) IN GENERAL.—For each of fiscal years 1993 through 1996,

the Secretary of Defense and the Secretary of Veterans Affairs

shall include in the annual report of the Secretaries under section

8111(f) of title 38, United States Code, a description of the Secretaries’ implementation of this section.

(b) ADDITIONAL MATTERS FOR FISCAL YEAR 1996 REPORT.—In

the report under subsection (a) for fiscal year 1996, the Secretaries

shall include the following:

(1) An assessment of the effect of agreements entered into

under section 201 on the delivery of health care to eligible veterans.

(2) An assessment of the cost savings, if any, associated

with provision of services under such agreements to retired

members of the Armed Forces, dependents of members or

former members of a uniformed service, and beneficiaries

under section 1713 of title 38, United States Code.

(3) Any plans for administrative action, and any recommendations for legislation, that the Secretaries consider appropriate to include in the report.

SEC. 207. ø38 U.S.C. 8111 note¿ AUTHORITY TO BILL HEALTH-PLAN CONTRACTS.

(a) RIGHT TO RECOVER.—In the case of a primary beneficiary

(as described in section 201(a)(2)(B)) who has coverage under a

health-plan contract, as defined in section 1729(i)(1)(A) of title 38,

United States Code, and who is furnished care or services by a Department medical facility pursuant to this title, the United States

shall have the right to recover or collect charges for such care or

services from such health-plan contract to the extent that the beneficiary (or the provider of the care or services) would be eligible to

receive payment for such care or services from such health-plan

contract if the care or services had not been furnished by a department or agency of the United States. Any funds received from such

health-plan contract shall be credited to funds that have been allotted to the facility that furnished the care or services.

(b) ENFORCEMENT.—The right of the United States to recover

under such a beneficiary’s health-plan contract shall be enforceable

in the same manner as that provided by subsections (a)(3), (b),

(c)(1), (d), (f), (h), and (i) of section 1729 of title 38, United States

Code.
204

1Section 712(c)(2)(A) of the Floyd D. Spence National Defense Authorization Act for Fiscal

Year 2001 (as enacted into law by Public Law 106–398; 114 Stat. 1654A–177) amends the heading of this section by striking ‘‘DEMONSTRATION PROJECT’’ and inserting ‘‘PROGRAM’’. Subsection

(f) of such section provides as follows:

(f ) CONDITIONAL EFFECTIVE DATE.—(1) Upon negotiating an agreement under the amendment

made by subsection (c)(1), the Secretary of Defense and the Secretary of Health and Human

Services shall jointly transmit a notification of the proposed agreement to the Committee on

Armed Services and the Committee on Finance of the Senate and the Committee on Armed

Services and the Committee on Ways and Means of the House of Representatives, and shall include with the transmittal a copy of the proposed agreement and all related agreements and

supporting documents.

(2) Such proposed agreement shall take effect, and the amendments made by subsections

(c)(2), (c)(3), (d), and (e) shall take effect, on such date as is provided for in such agreement

and in an Act enacted after the date of the enactment of this Act.

2Subject to the conditional effective date referred to in the first footnote to this section, section 712(c)(2)(C) of the Floyd D. Spence National Defense Authorization Act for Fiscal Year 2001

(as enacted into law by Public Law 106–398; 114 Stat. 1654A–177) amends the entire section

by striking ‘‘DEMONSTRATION PROJECT’’ and ‘‘demonstration project’’ and ‘‘project’’ each place

each appears and inserting ‘‘PROGRAM’’, ‘‘program’’, and ‘‘program’’ respectively. 3Subject to the conditional effective date referred to in the first footnote to this section, section 712(c)(2)(B) of the Floyd D. Spence National Defense Authorization Act for Fiscal Year 2001

(as enacted into law by Public Law 106–398; 114 Stat. 1654A–177) amends paragraph (2) to

read as follows:

‘‘(2) PROGRAM.—The term ‘program’ means the program carried out under this section.’’;

MEDICARE SUBVENTION FOR MILITARY RETIREES

SECTION 1896 OF TITLE XVIII OF THE SOCIAL SECURITY

ACT (42 U.S.C. 1395ggg)

(as added by section 4015 of the Balanced Budget Act of 1997; Public Law 105–33,

approved August 5, 1997)

MEDICARE SUBVENTION DEMONSTRATION PROJECT 1 FOR MILITARY

RETIREES

SEC. 1896. 2 ø42 U.S.C. 1395ggg¿ (a) DEFINITIONS.—In this section:

(1) ADMINISTERING SECRETARIES.—The term ‘‘administering Secretaries’’ means the Secretary and the Secretary of

Defense acting jointly.

(2) 3 DEMONSTRATION PROJECT; PROJECT.—The terms ‘‘demonstration project’’ and ‘‘project’’ mean the demonstration

project carried out under this section.

(3) DESIGNATED PROVIDER.—The term ‘‘designated provider’’ has the meaning given that term in section 721(5) of the

National Defense Authorization Act For Fiscal Year 1997 (Public Law 104–201; 110 Stat. 2593; 10 U.S.C. 1073 note).

(4) MEDICARE-ELIGIBLE MILITARY RETIREE OR DEPEND- ENT.—The term ‘‘medicare-eligible military retiree or dependent’’ means an individual described in section 1074(b) or

1076(b) of title 10, United States Code, who—

(A) is eligible for health benefits under section 1086 of

such title by reason of subsection (c)(1) of such section;
205 Sec. 1896 MEDICARE SUBVENTION FOR MILITARY RETIREES

(B)(i) is entitled to benefits under part A of this title;

and

(ii) if the individual was entitled to such benefits before July 1, 1997, received health care items or services

from a health care facility of the uniformed services before

that date, but after becoming entitled to benefits under

part A of this title;

(C) is enrolled for benefits under part B of this title;

and

(D) has attained age 65.

(5) MEDICARE HEALTH CARE SERVICES.—The term ‘‘medicare health care services’’ means items or services covered

under part A or B of this title.

(6) MILITARY TREATMENT FACILITY.—The term ‘‘military

treatment facility’’ means a facility referred to in section

1074(a) of title 10, United States Code.

(7) TRICARE.—The term ‘‘TRICARE’’ has the same meaning as the term ‘‘TRICARE program’’ under section 711 of the

National Defense Authorization Act for Fiscal Year 1996 (10

U.S.C. 1073 note).

(8) TRUST FUNDS.—The term ‘‘trust funds’’ means the Federal Hospital Insurance Trust Fund established in section 1817

and the Federal Supplementary Medical Insurance Trust Fund

established in section 1841.

(b) DEMONSTRATION PROJECT.—

(1) IN GENERAL.—

(A) ESTABLISHMENT.—The administering Secretaries

are authorized to establish a demonstration project (under

an agreement entered into by the administering Secretaries) under which the Secretary shall reimburse the Secretary of Defense, from the trust funds, for medicare

health care services furnished to certain medicare-eligible

military retirees or dependents in a military treatment facility or by a designated provider.

(B) AGREEMENT.—The agreement entered into under

subparagraph (A) shall include at a minimum—

(i) a description of the benefits to be provided to

the participants of the demonstration project established under this section;

(ii) a description of the eligibility rules for participation in the demonstration project, including any cost

sharing requirements;

(iii) a description of how the demonstration project

will satisfy the requirements under this title;

(iv) a description of the sites selected under paragraph (2);

(v) a description of how reimbursement requirements under subsection (i) and maintenance of effort

requirements under subsection (j) will be implemented

in the demonstration project;

(vi) a statement that the Secretary shall have access to all data of the Department of Defense that the

Secretary determines is necessary to conduct independent estimates and audits of the maintenance of
Sec. 1896 MEDICARE SUBVENTION FOR MILITARY RETIREES 206

4Subject to the conditional effective date referred to in the first footnote to this section, section 712(d)(1) of the Floyd D. Spence National Defense Authorization Act for Fiscal Year 2001

(as enacted into law by Public Law 106–398; 114 Stat. 1654A–178) amends paragraph (2) to

read as follows:

‘‘(2) LOCATION OF SITES.—Subject to subsection (k)(2)(B), the program shall be conducted

in any site that is designated jointly by the administering Secretaries.’’.

effort requirement, the annual reconciliation, and related matters required under the demonstration

project;

(vii) a description of any requirement that the Secretary waives pursuant to subsection (d); and

(viii) a certification, provided after review by the

administering Secretaries, that any entity that is receiving payments by reason of the demonstration

project has sufficient—

(I) resources and expertise to provide, consistent with payments under subsection (i), the

full range of benefits required to be provided to

beneficiaries under the project; and

(II) information and billing systems in place

to ensure the accurate and timely submission of

claims for benefits and to ensure that providers of

services, physicians, and other health care professionals are reimbursed by the entity in a timely

and accurate manner.

(2) 4 NUMBER OF SITES.—The project established under this

section shall be conducted in no more than 6 sites, designated

jointly by the administering Secretaries after review of all

TRICARE regions.

(3) RESTRICTION.—No new military treatment facilities will

be built or expanded with funds from the demonstration

project.

(4) DURATION.—The administering Secretaries shall conduct the demonstration project during the 4-year period beginning on January 1, 1998, except that the administering Secretaries may negotiate and (subject to section 712(f) of the Floyd

D. Spence National Defense Authorization Act for Fiscal Year

2001) enter into a new or revised agreement under paragraph

(1)(A) to continue the project after the end of such period. If

the project is so continued, the administering Secretaries may

terminate the agreement under which the program operates

after providing notice to Congress in accordance with subsection (k)(2)(B)(v).

(5) REPORT.—At least 60 days prior to the commencement

of the demonstration project, the administering Secretaries

shall submit a copy of the agreement entered into under paragraph (1) to the committees of jurisdiction under this title.

(c) CREDITING OF PAYMENTS.—A payment received by the Secretary of Defense under the demonstration project shall be credited

to the applicable Department of Defense medical appropriation

(and within that appropriation). Any such payment received during

a fiscal year for services provided during a prior fiscal year may be

obligated by the Secretary of Defense during the fiscal year during

which the payment is received.
207 Sec. 1896 MEDICARE SUBVENTION FOR MILITARY RETIREES

5Subject to the conditional effective date referred to in the first footnote to this section, section 712(d)(2) of the Floyd D. Spence National Defense Authorization Act for Fiscal Year 2001

(as enacted into law by Public Law 106–398; 114 Stat. 1654A–178) amends paragraph (2) by

inserting ‘‘, or (subject to subsection (k)(2)(B)) such comparable requirements as are included in

the agreement under subsection (b)(1)(A)’’ after ‘‘the following areas’’.

(d) WAIVER OF CERTAIN MEDICARE REQUIREMENTS.—

(1) AUTHORITY.—

(A) IN GENERAL.—Except as provided under subparagraph (B), the demonstration project shall meet all requirements of Medicare+Choice plans under part C of this

title and regulations pertaining thereto, and other requirements for receiving medicare payments, except that the

prohibition of payments to Federal providers of services

under sections 1814(c) and 1835(d), and paragraphs (2)

and (3) of section 1862(a) shall not apply.

(B) WAIVER.—Except as provided in paragraph (2), the

Secretary is authorized to waive any requirement described under subparagraph (A), or approve equivalent or

alternative ways of meeting such a requirement, but only

if such waiver or approval—

(i) reflects the unique status of the Department of

Defense as an agency of the Federal Government; and

(ii) is necessary to carry out the demonstration

project.

(2) BENEFICIARY PROTECTIONS AND OTHER MATTERS.—The

demonstration project shall comply with the requirements of

part C of this title that relate to beneficiary protections and

other matters, including such requirements relating to the following areas 5:

(A) Enrollment and disenrollment.

(B) Nondiscrimination.

(C) Information provided to beneficiaries.

(D) Cost-sharing limitations.

(E) Appeal and grievance procedures.

(F) Provider participation.

(G) Access to services.

(H) Quality assurance and external review.

(I) Advance directives.

(J) Other areas of beneficiary protections that the Secretary determines are applicable to such project.

(e) INSPECTOR GENERAL.—Nothing in the agreement entered

into under subsection (b) shall limit the Inspector General of the

Department of Health and Human Services from investigating any

matters regarding the expenditure of funds under this title for the

demonstration project, including compliance with the provisions of

this title and all other relevant laws.

(f) VOLUNTARY PARTICIPATION.—Participation of medicare-eligible military retirees or dependents in the demonstration project

shall be voluntary.

(g) TRICARE HEALTH CARE PLANS.— (1) MODIFICATION OF TRICARE CONTRACTS.—In carrying out

the demonstration project, the Secretary of Defense is authorized to amend existing TRICARE contracts (including contracts

with designated providers) in order to provide the medicare
Sec. 1896 MEDICARE SUBVENTION FOR MILITARY RETIREES 208

6Subject to the conditional effective date referred to in the first footnote to this section, section 712(d)(3)(A) of the Floyd D. Spence National Defense Authorization Act for Fiscal Year 2001

(as enacted into law by Public Law 106–398; 114 Stat. 1654A–178) amends paragraph (2) of subsection (i) by inserting ‘‘subject to paragraph (4),’’ after ‘‘paragraph (1)’’. 7Subject to the conditional effective date referred to in the first footnote to this section, section 712(c)(3) of the Floyd D. Spence National Defense Authorization Act for Fiscal Year 2001

(as enacted into law by Public Law 106–398; 114 Stat. 1654A–177) amends paragraph (4) of subsection (i) to read as follows:

health care services to the medicare-eligible military retirees

and dependents enrolled in the demonstration project consistent with part C of this title.

(2) HEALTH CARE BENEFITS.—The administering Secretaries shall prescribe the minimum health care benefits to be

provided under such a plan to medicare-eligible military retirees or dependents enrolled in the plan. Those benefits shall include at least all medicare health care services covered under

this title.

(h) ADDITIONAL PLANS.—Notwithstanding any provisions of

title 10, United States Code, the administering Secretaries may

agree to include in the demonstration project any of the

Medicare+Choice plans described in section 1851(a)(2)(A), and such

agreement may include an agreement between the Secretary of Defense and the Medicare+Choice organization offering such plan to

provide medicare health care services to medicare-eligible military

retirees or dependents and for such Secretary to receive payments

from such organization for the provision of such services.

(i) PAYMENTS BASED ON REGULAR MEDICARE PAYMENT

RATES.—

(1) IN GENERAL.—Subject to the succeeding provisions of

this subsection, the Secretary shall reimburse the Secretary of

Defense for services provided under the demonstration project

at a rate equal to 95 percent of the amount paid to a

Medicare+Choice organization under part C of this title with

respect to such an enrollee. In cases in which a payment

amount may not otherwise be readily computed, the Secretary

shall establish rules for computing equivalent or comparable

payment amounts.

(2) EXCLUSION OF CERTAIN AMOUNTS.—In computing the

amount of payment under paragraph (1) 6, the following shall

be excluded:

(A) SPECIAL PAYMENTS.—Any amount attributable to

an adjustment under subparagraphs (B) and (F) of section

1886(d)(5) and subsection (h) of such section.

(B) PERCENTAGE OF CAPITAL PAYMENTS.—An amount

determined by the administering Secretaries for amounts

attributable to payments for capital-related costs under

subsection (g) of such section.

(3) PERIODIC PAYMENTS FROM MEDICARE TRUST FUNDS.—

Payments under this subsection shall be made—

(A) on a periodic basis consistent with the periodicity

of payments under this title; and

(B) in appropriate part, as determined by the Secretary, from the trust funds.

(4) 7 CAP ON AMOUNT.—The aggregate amount to be reimbursed under this subsection pursuant to the agreement en-
209 Sec. 1896 MEDICARE SUBVENTION FOR MILITARY RETIREES

‘‘(4) CAP ON AMOUNT.—The maximum aggregate expenditures from the trust funds under

this subsection pursuant to the agreement entered into between the administering Secretaries under subsection (b) for a fiscal year (before fiscal year 2006) shall not exceed the

amount agreed by the Secretaries to be the amount that would have been expended from

the trust funds on beneficiaries who enroll in the program, had the program not been established, plus the following:

‘‘(A) $35,000,000 for fiscal year 2002.

‘‘(B) $55,000,000 for fiscal year 2003.

‘‘(C) $75,000,000 for fiscal year 2004.

‘‘(D) $100,000,000 for fiscal year 2005.’’.

Subject to the conditional effective date referred to in the first footnote to this section, section

712(d)(3)(B) of such Act (114 Stat. 1654A–178) also provides for an amendment to strike paragraph (4) of subsection (i) and insert a new paragraph as follows:

‘‘(4) MODIFICATION OF PAYMENT METHODOLOGY.—The administering Secretaries may, subject to subsection (k)(2)(B), modify the payment methodology provided under paragraphs (1)

and (2) so long as the amount of the reimbursement provided to the Secretary of Defense

fully reimburses the Department of Defense for its cost of providing services under the program but does not exceed an amount that is estimated to be equivalent to the amount that

otherwise would have been expended under this title for such services if provided other than

under the program (not including amounts described in paragraph (2)). Such limiting

amount may be based for any site on the amount that would be payable to Medicare+Choice

organizations under part C for the area of the site or the amounts that would be payable

under parts A and B.’’. 8Subject to the conditional effective date referred to in the first footnote to this section, section 712(c)(2)(D) of the Floyd D. Spence National Defense Authorization Act for Fiscal Year 2001

(as enacted into law by Public Law 106–398; 114 Stat. 1654A–177) amends the heading of subsection (j)(1) by striking ‘‘DEMONSTRATION’’.

tered into between the administering Secretaries under subsection (b) shall not exceed a total of—

(A) $50,000,000 for calendar year 1998;

(B) $60,000,000 for calendar year 1999;

(C) $65,000,000 for calendar year 2000; and

(D) $70,000,000 for calendar year 2001.

(j) MAINTENANCE OF EFFORT.— (1) MONITORING EFFECT OF DEMONSTRATION 8 PROGRAM ON

COSTS TO MEDICARE PROGRAM.— (A) IN GENERAL.—The administering Secretaries, in

consultation with the Comptroller General, shall closely

monitor the expenditures made under the medicare program for medicare-eligible military retirees or dependents

during the period of the demonstration project compared to

the expenditures that would have been made for such

medicare-eligible military retirees or dependents during

that period if the demonstration project had not been conducted. The agreement entered into by the administering

Secretaries under subsection (b) shall require any participating military treatment facility to maintain the level of

effort for space available care to medicare-eligible military

retirees or dependents.

(B) ANNUAL REPORT BY THE COMPTROLLER GENERAL.—

Not later than December 31 of each year during which the

demonstration project is conducted, the Comptroller General shall submit to the administering Secretaries and the

appropriate committees of Congress a report on the extent,

if any, to which the costs of the Secretary under the medicare program under this title increased during the preceding fiscal year as a result of the demonstration project.

(2) REQUIRED RESPONSE IN CASE OF INCREASE IN COSTS.—

(A) IN GENERAL.—If the administering Secretaries

find, based on paragraph (1), that the expenditures under
Sec. 1896 MEDICARE SUBVENTION FOR MILITARY RETIREES 210

the medicare program under this title increased (or are expected to increase) during a fiscal year because of the demonstration project, the administering Secretaries shall take

such steps as may be needed—

(i) to recoup for the medicare program the amount

of such increase in expenditures; and

(ii) to prevent any such increase in the future.

(B) STEPS.—Such steps—

(i) under subparagraph (A)(i) shall include payment of the amount of such increased expenditures by

the Secretary of Defense from the current medical care

appropriation of the Department of Defense to the

trust funds; and

(ii) under subparagraph (A)(ii) shall include suspending or terminating the demonstration project (in

whole or in part) or lowering the amount of payment

under subsection (i)(1).

(k) EVALUATION AND REPORTS.— (1) INDEPENDENT EVALUATION.—The Comptroller General

of the United States shall conduct an evaluation of the demonstration project, and shall submit annual reports on the

demonstration project to the administering Secretaries and to

the committees of jurisdiction in the Congress. The first report

shall be submitted not later than 12 months after the date on

which the demonstration project begins operation, and the

final report not later than 31⁄2 years after that date. The evaluation and reports shall include an assessment, based on the

agreement entered into under subsection (b), of the following:

(A) Any savings or costs to the medicare program

under this title resulting from the demonstration project.

(B) The cost to the Department of Defense of providing

care to medicare-eligible military retirees and dependents

under the demonstration project.

(C) A description of the effects of the demonstration

project on military treatment facility readiness and training and the probable effects of the project on overall Department of Defense medical readiness and training.

(D) Any impact of the demonstration project on access

to care for active duty military personnel and their dependents.

(E) An analysis of how the demonstration project affects the overall accessibility of the uniformed services

treatment system and the amount of space available for

point-of-service care, and a description of the unintended

effects (if any) upon the normal treatment priority system.

(F) Compliance by the Department of Defense with the

requirements under this title.

(G) The number of medicare-eligible military retirees

and dependents opting to participate in the demonstration

project instead of receiving health benefits through another health insurance plan (including benefits under this

title).

(H) A list of the health insurance plans and programs

that were the primary payers for medicare-eligible military
211 Sec. 1896 MEDICARE SUBVENTION FOR MILITARY RETIREES

9Subject to the conditional effective date referred to in the first footnote to this section, subsection (e) of section 712 of the Floyd D. Spence National Defense Authorization Act for Fiscal

Year 2001 (as enacted into law by Public Law 106–398; 114 Stat. 1654A–178) would have

amended subsection (k)(2) to establish a new reporting requirement. However, section 713 of the

Bob Stump National Defense Authorization Act for Fiscal Year 2003 (Public Law 107–314; 116

Stat. 2589) provides as follows: ‘‘Notwithstanding subsection (f)(2) of section 712 of the Floyd

D. Spence National Defense Authorization Act for Fiscal Year 2001 (as enacted into law by Public Law 106-398; 114 Stat. 1654A–179), the amendment made by subsection (e) of such section

shall not take effect and the paragraph amended by such subsection is repealed.’’.

retirees and dependents during the year prior to their participation in the demonstration project and the distribution

of their previous enrollment in such plans and programs.

(I) Any impact of the demonstration project on private

health care providers and beneficiaries under this title

that are not enrolled in the demonstration project.

(J) An assessment of the access to care and quality of

care for medicare-eligible military retirees and dependents

under the demonstration project.

(K) An analysis of whether, and in what manner, easier access to the uniformed services treatment system affects the number of medicare-eligible military retirees and

dependents receiving medicare health care services.

(L) Any impact of the demonstration project on the access to care for medicare-eligible military retirees and dependents who did not enroll in the demonstration project

and for other individuals entitled to benefits under this

title.

(M) A description of the difficulties (if any) experienced by the Department of Defense in managing the demonstration project and TRICARE contracts.

(N) Any additional elements specified in the agreement entered into under subsection (b).

(O) Any additional elements that the Comptroller General of the United States determines is appropriate to assess regarding the demonstration project.

ø(2) Repealed.¿ 9

213

TABLES

DEFENSE-RELATED HEALTH LAWS

(215)

LIST BY PUBLIC LAW NUMBER OF SELECTED DEFENSE-RELATED

HEALTH LAWS

Public Law Short title

101–510 ... National Defense Authorization Act for Fiscal Year 1991 (Nov. 5, 1990;

H.R. 4739). Title VII contains health care provisions.

102–190 ... National Defense Authorization Act for Fiscal Years 1992 and 1993

(Dec. 5, 1991; H.R. 2100). Title VII contains health care provisions.

102–484 ... National Defense Authorization Act for Fiscal Year 1993 (Oct. 23,

1992; H.R. 5006). Title VII contains health care provisions.

102–585 ... Veterans Health Care Act of 1992 (Nov. 4, 1992; H.R. 5193). Title VII

contains the Persian Gulf War Veterans’ Health Status Act.

103–160 ... National Defense Authorization Act for Fiscal Year 1994 (Nov. 30,

1993; H.R. 2401). Title VII contains health care provisions.

103–337 ... National Defense Authorization Act for Fiscal Year 1995 (Oct. 5, 1994;

S. 2182). Title VII contains health care provisions.

103–446 ... Veterans’ Benefits Improvements Act of 1994 (Nov. 2, 1994; H.R. 5244)

Title I contains the Persian Gulf War Veterans’ Benefits Act.

104–106 ... National Defense Authorization Act for Fiscal Year 1996 (Feb. 10,

1996; S. 1124). Title VII contains health care provisions.

104–201 ... National Defense Authorization Act for Fiscal Year 1997 (Sept. 23,

1996; H.R. 3230). Title VII contains health care provisions.

105–33 ..... Balanced Budget Act of 1997 (Aug. 5, 1997; H.R. 2015). Section 4015

relates to a medicare subvention project for military retirees.

105–85 ..... National Defense Authorization Act for Fiscal Year 1998 (Nov. 18,

1997; H.R. 1119). Title VII contains health care provisions.

105–261 ... Strom Thurmond National Defense Authorization Act for Fiscal Year

1999 (Oct. 17, 1998; H.R. 3616). Title VII contains health care provisions.

106–65 ..... National Defense Authorization Act for Fiscal Year 2000 (Oct. 5, 1999;

S. 1059). Title VII contains health care provisions.

106–117 ... Veterans Millennium Health Care and Benefits Act (Nov. 30, 1999;

H.R. 2116)

106–259 ... Department of Defense Appropriations Act, 2001 (Aug. 9, 2000; H.R.

4576).

106–398 ... [enacted the] Floyd D. Spence National Defense Authorization Act for

Fiscal Year 2001 (Oct. 30, 2000; H.R. 4205) Title VII of the Appendix contains health care provisions.

107–107 ... National Defense Authorization Act for Fiscal Year 2002 (Dec. 28,

2001; S. 1438). Title VII contains health care provisions.

107–314 ... Bob Stump National Defense Authorization Act for Fiscal Year 2003

(Dec. 2, 2002; H.R. 4546). Title VII contains health care provisions.

108–87 ..... Department of Defense Appropriations Act, 2004 (Sept. 30, 2003; H.R.

2658).

108–106 ... Emergency Supplemental Appropriations Act for Defense and for the

Reconstruction of Iraq and Afghanistan, 2004 (Nov. 6, 2003; H.R.

3289)

108–136 ... National Defense Authorization Act for Fiscal Year 2004 (Nov. 24,

2003; H.R. 1588). Title VII contains health care provisions.

(217)

LIST BY SHORT TITLE OR POPULAR NAME OF SELECTED DEFENSERELATED HEALTH LAWS

[Note: A title in quotations is not statutorily designated as the short title]

Short title or popular name Public Law number or U.S. Code citation

Balanced Budget Act of 1997 ................... P.L. 105–33. Section 4015 relates to a

medicare subvention project for military retirees.

Bob Stump National Defense Authorization Act for Fiscal Year 2003.P.L. 107–314.

Department of Defense Appropriations

Act, 2004.

P.L. 108–87.

Emergency Supplemental Appropriations

Act for Defense and for the Reconstruction of Iraq and Afghanistan,

2004.

P.L. 108–106

Floyd D. Spence National Defense Authorization Act for Fiscal Year 2001.P.L. 106–398.

National Defense Authorization Act for

Fiscal Year 1991.

P.L. 101–510.

National Defense Authorization Act for

Fiscal Years 1992 and 1993.

P.L. 102–190.

National Defense Authorization Act for

Fiscal Year 1993.

P.L. 102–484.

National Defense Authorization Act for

Fiscal Year 1994.

P.L. 103–160.

National Defense Authorization Act for

Fiscal Year 1995.

P.L. 103–337.

National Defense Authorization Act for

Fiscal Year 1996.

P.L. 104–106.

National Defense Authorization Act for

Fiscal Year 1997.

P.L. 104–201.

National Defense Authorization Act for

Fiscal Year 1998.

P.L. 105–85.

‘‘National Defense Authorization Act for

Fiscal Year 1999’’.

See Strom Thurmond National Defense

Authorization Act for Fiscal Year 1999

National Defense Authorization Act for

Fiscal Year 2000.

P.L. 106–65.

‘‘National Defense Authorization Act for

Fiscal Year 2001’’.

See Floyd D. Spence National Defense

Authorization Act for Fiscal Year

2001.

National Defense Authorization Act for

Fiscal Year 2002.

P.L. 107–107.

‘‘National Defense Authorization Act for

Fiscal Year 2003’’.

See Bob Stump National Defense Authorization Act for Fiscal Year 2003.

National Defense Authorization Act for

Fiscal Year 2004.

P.L. 108–136.

Persian Gulf War Veterans’ Benefits Act Title I of P.L. 103–446 (38 U.S.C 1117

note).

Persian Gulf War Veterans’ Health Status Act.Title VII of P.L. 102–585 (38 U.S.C 527

note).

Strom Thurmond National Defense Authorization Act for Fiscal Year 1999.P.L. 105–261.

Veterans Health Care Act of 1992 ........... P.L. 102–585

Veterans’ Benefits Improvements Act of

1994.

P.L. 103–446

Veterans Millennium Health Care and

Benefits Act.

P.L. 106–117

(219)

LIST BY SELECTED SUBJECT AREAS OF DEFENSE-RELATED HEALTH

LAWS

Subject Section of U.S. Code or of public law

CHAMPUS program .............................. See ‘‘TRICARE’’.

Chemical or biological agents ............ Section 1078 of the National Defense

Authorization Act for Fiscal Year 1998

(P.L. 105–85; 50 U.S.C. 1520a), relating to restrictions on the use of human

subjects for testing of chemical or biological agents.

Gulf War veterans, health care

issues relating to.

Section 743 of National Defense Authorization Act for Fiscal Year 1997 (P.L.

104–201; 10 U.S.C. 1074 note).

Persian Gulf War Veterans Benefits Act

(title I of P.L. 103-446; 38 U.S.C. 1117

note).

Section 721 of the National Defense Authorization Act for Fiscal Year 1995

(P.L. 103–337; 10 U.S.C. 1074 note).

Persian Gulf War Veterans’ Health Status Act (title VII of P.L. 102–585; 38

U.S.C. 527 note).

Section 734 of the National Defense Authorization Act for Fiscal Years 1992

and 1993 (P.L. 102–190; 10 U.S.C.

1074 note).

Medicare, health care issues relating to.Section 722 of the Strom Thurmond National Defense Authorization Act for

Fiscal Year 1999 (P.L. 105–261; 10

U.S.C. 1073 note) relating to

TRICARE as supplement to medicare

demonstration.

Section 1896 of title XVIII of the Social

Security Act (as added by section 4015

of the Balanced Budget Act of 1997;

P.L. 105–33; 42 U.S.C. 1395ggg), relating to Medicare subvention demonstration project for military retirees.

Public Health Service Hospitals,

military use of former.

Subtitle C of title VII of the National

Defense Authorization Act for Fiscal

Year 1997 (P.L. 104–201; 10 U.S.C.

1073 note).

Sharing agreements (health care)

between Department of Defense

and Department of Veterans Affairs.

Sections 8111 and 8111A of title 38,

U.S.C.
220

Subject Section of U.S. Code or of public law

Section 727 of the National Defense Authorization Act for Fiscal Year 2004

(P.L. 108–136; 38 U.S.C. 320 note), relating to joint program for development and evaluation of integrated

healing care practices for members of

the Armed Forces and veterans.

Subtitle C of the Bob Stump National

Defense Authorization Act for Fiscal

Year 2003 (P.L. 107–314; 38 U.S.C.

8111 note), relating to Department of

Defense-Department of Veterans Affairs health resources sharing.

Section 734 of the National Defense Authorization Act for Fiscal Year 2002

(P.L. 107–107; 10 U.S.C. 1071 note),

relating to pilot program providing for

Department of Veterans Affairs support in the performance of separation

physical examinations.

Subtitle E of title VII of the Floyd D.

Spence National Defense Authorization Act for Fiscal Year 2001 (P.L.

106–398; 38 U.S.C. 8111 note), relating to joint initiatives with Department of Veterans Affairs.

Section 113 of the Veterans Millennium

Health Care and Benefits Act (P.L.

106–117; 38 U.S.C. 8111 note), relating to access to care for TRICARE-eligible military retirees.

Section 724 of the National Defense Authorization Act for Fiscal Year 2000

(P.L. 106–65; 10 U.S.C. 1092 note), relating to joint telemedicine and telepharmacy demonstration projects.

Section 745 of the Strom Thurmond National Defense Authorization Act for

Fiscal Year 1999 (P.L. 105–261; 10

U.S.C. 1071 note), relating to interdepartmental cooperation in the delivery of medical care.

Title II of the Veterans Health Care Act

of 1992 (P.L. 102–585; 38 U.S.C. 8111

note).

TRICARE and CHAMPUS programs Sections 723 and 724 of the National Defense Authorization Act for Fiscal Year

2004 (P.L. 108–136; 38 U.S.C. 320

note), relating to surveys on continued

viability of TRICARE Standard and

plan for providing health coverage information to members, former members, and dependents eligible for certain health benefits.

Section 708 of the Bob Stump National

Defense Authorization Act for Fiscal

Year 2003 (P.L. 107–314; 10 U.S.C.

1071 note), relating to access to health

care services for beneficiaries eligible

for TRICARE and Department of Veterans Affairs health care.
221

Subject Section of U.S. Code or of public law

Sections 721, 723, 724, and 727 of the

Floyd D. Spence National Defense Authorization Act for Fiscal Year 2001

(P.L. 106–398; 10 U.S.C. 1073), relating to improvement of access to health

care under the TRICARE program;

modernization of TRICARE business

practices and increase of use of military treatment facilities; extension of

TRICARE managed care support contracts; and claims processing improvements.

Section 8090 of the Department of Defense Appropriations Act, 2001 (P.L.

106–259, 10 U.S.C. 1073 note), relating to TRICARE managed care support contracts.

Sections 722, 723, and 724 of the Strom

Thurmond National Defense Authorization Act for Fiscal Year 1999 (P.L.

105–261) relating to TRICARE as supplement to medicare demonstration

[10 U.S.C. 1073 note]; implementation

of redesign of pharmacy system [10

U.S.C. 1073 note]; and comprehensive

evaluation of implementation of demonstration projects and TRICARE

pharmacy redesign [10 U.S.C. 1108

note].

Sections 711, 715, 717, and 743 of the

National Defense Authorization Act

for Fiscal Year 1996 (P.L. 104–106),

relating to definition of TRICARE program; training in health care management and administration for

TRICARE lead agents [10 U.S.C. 1073

note]; evaluation and report on

TRICARE program effectiveness [10

U.S.C. 1073 note]; and waiver of collection of payments due from certain

persons unaware of loss of CHAMPUS

eligibility [10 U.S.C. 1086 note].

Section 731 of National Defense Authorization Act for Fiscal Year 1994 (P.L.

103–160; 10 U.S.C.1073 note), relating

to use of health maintenance organization model as option for military

health care.

Sections 711, 712, and 715 of the National Defense Authorization Act for

Fiscal Year 1993 (P.L. 102–484), relating to national claims processing system for CHAMPUS [10 U.S.C. 1106

note]; condition on expansion of

CHAMPUS reform initiative to other

locations [10 U.S.C. 1073 note]; and

positive incentives under the coordinated care program.

Section 722 of the National Defense Authorization Act for Fiscal Years 1992

and 1993 (P.L. 102–190; 10 U.S.C.

1073 note), relating to authorization

for the extension of CHAMPUS reform

initiative.
222

Subject Section of U.S. Code or of public law

Section 715 of the National Defense Authorization Act for Fiscal Year 1991

(P.L. 101–510; 10 U.S.C. 1073 note),

relating to conditions on expansion of

CHAMPUS reform initiative.

Veterans Affairs, Department of,

health care sharing agreements

with Department of Defense.

See ‘‘sharing agreements’’.