II

105TH CONGRESS

2D SESSION S. 2045

To amend title 10, United States Code, to permit certain beneficiaries of

the military health care system to enroll in Federal employees health

benefits plans, and for other purposes.

IN THE SENATE OF THE UNITED STATES

MAY 7, 1998

Mr. FAIRCLOTH introduced the following bill; which was read twice and

referred to the Committee on Armed Services

A BILL

To amend title 10, United States Code, to permit certain

beneficiaries of the military health care system to enroll

in Federal employees health benefits plans, and for other

purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Improved Military

5 Medical Plan Act’’.
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1 SEC. 2. INCLUSION OF CERTAIN COVERED BENEFICIARIES

2 IN FEDERAL EMPLOYEES HEALTH BENEFITS

3 PROGRAM.

4 (a) FEHBP OPTION.—(1) Chapter 55 of title 10,

5 United States Code, is amended by inserting after section

6 1079a the following new section:

7 ‘‘§ 1079b. Health care coverage through Federal Em8 ployees Health Benefits program

9 ‘‘(a) FEHBP OPTION.—(1) Subject to the availabil10 ity of funds to carry out this section for a fiscal year and

11 subject to the provisions of this section, eligible bene12 ficiaries described in subsection (b) shall be afforded an

13 opportunity to enroll in any health benefits plan under the

14 Federal Employees Health Benefits program under chap15 ter 89 of title 5 that offers medical care comparable to

16 the care authorized by section 1077 of this title to be pro17 vided under section 1076 of this title (in this section re18 ferred to as an ‘FEHBP plan’).

19 ‘‘(2) The administering Secretaries shall enter into

20 an agreement with the Director of the Office of Personnel

21 Management to carry out paragraph (1).

22 ‘‘(b) ELIGIBLE BENEFICIARIES.—(1) An eligible ben23 eficiary referred to in subsection (a) is any member or

24 former member of the uniformed services described in sec25 tion 1074(b) of this title, or any dependents of such mem26 ber or former member described in section 1076(b) of this
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1 title, who is entitled to benefits under part A of title XVIII

2 of the Social Security Act (42 U.S.C. 1395c et seq.).

3 ‘‘(2) An eligible beneficiary under this subsection

4 shall not be required to satisfy any eligibility criteria speci5 fied in chapter 89 of title 5 as a condition for enrollment

6 in an FEHBP plan under this section.

7 ‘‘(c) AREAS OF ENROLLMENT.—(1)(A) Except as

8 provided in paragraph (2), the Director of the Office of

9 Personnel Management shall, in consultation with the ad10 ministering Secretaries, select the areas in which eligible

11 beneficiaries must reside in order to be permitted to enroll

12 in FEHBP plans under this section. The Director shall

13 select the largest number of such areas that is practicable.

14 ‘‘(B) The areas selected by the Director under sub15 paragraph (A) shall include not less than six regions under

16 the TRICARE program, with at least one such region in17 cluding a site of the medicare subvention demonstration

18 project for military retirees under section 1896 of the So19 cial Security Act (42 U.S.C. 1395ggg).

20 ‘‘(2) Commencing not later than one year after the

21 date of submittal of the report required by subsection

22 (j)(2), eligible beneficiaries nationwide shall be afforded

23 an opportunity to enroll in an FEHBP plan in accordance

24 with this section.
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1 ‘‘(d) PRIORITIES; LIST.—(1) Eligible beneficiaries

2 shall be permitted to enroll in an FEHBP plan under this

3 section based on the order in which such beneficiaries sub4 mit to the administering Secretary concerned an applica5 tion to enroll in an FEHBP plan under this section.

6 ‘‘(2) Each administering Secretary shall maintain a

7 list of eligible beneficiaries who apply to enroll in an

8 FEHBP plan under this section, but whom such Secretary

9 is not able to enroll because of the lack of available funds

10 to carry out this section.

11 ‘‘(3) Eligible beneficiaries who are on a list under

12 paragraph (2) at the time of the expansion of opportuni13 ties for eligible beneficiaries to enroll in FEHBP plans

14 under subsection (c)(2) shall resubmit an application

15 under this subsection to be afforded an opportunity to en16 roll in an FEHBP plan under this section.

17 ‘‘(e) PERIOD OF ENROLLMENT.—The administering

18 Secretaries shall provide a period of enrollment for eligible

19 beneficiaries in FEHBP plans under this section for a pe20 riod of 90 days—

21 ‘‘(1) before the commencement of the availabil22 ity of care under such plans under this section; and

23 ‘‘(2) for each subsequent year thereafter.

24 ‘‘(f) TERM OF ENROLLMENT.—(1) An eligible bene25 ficiary who elects to participate in a plan under the Fed-
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1 eral Employees Health Benefits program under this sec2 tion shall participate continuously in such a plan (whether

3 in the plan originally elected or another plan) during the

4 three-year period beginning on the date of commencement

5 of the beneficiary’s participation in such a plan under this

6 section.

7 ‘‘(2) An eligible beneficiary who discontinues partici8 pation in a plan under the Federal Employees Health

9 Benefits program under this section before the end of the

10 period described in paragraph (1) shall not be eligible to

11 reenroll in any plan under the program under this section.

12 ‘‘(g) RECEIPT OF CARE IN MILITARY TREATMENT

13 FACILITIES.—(1) An eligible beneficiary enrolled in an

14 FEHBP plan under this section may receive care at a

15 military medical treatment facility subject to the availabil16 ity of space in such facility.

17 ‘‘(2) The FEHBP plan concerned shall reimburse a

18 facility for the cost of treatment provided under paragraph

19 (1) to an eligible beneficiary enrolled in the plan under

20 this section.

21 ‘‘(3) An FEHBP plan may adjust the copayments of

22 an eligible beneficiary enrolled in the plan under this sec23 tion so that receipt of care by the beneficiary at a military

24 medical treatment facility results in no additional costs to

25 the plan when compared with the costs the plan would
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1 have incurred if the beneficiary had received such care

2 from a provider in the plan.

3 ‘‘(h) CONTRIBUTIONS.—(1) Contributions shall be

4 made for an eligible beneficiary who enrolls in an FEHBP

5 plan under this section as if the beneficiary were an em6 ployee of the Federal Government.

7 ‘‘(2) The administering Secretary concerned shall be

8 responsible for the Government contributions that the Di9 rector of the Office of Personnel Management determines

10 would be payable by such Secretary under section 8906

11 of title 5 for an eligible beneficiary who is enrolled in an

12 FEHBP plan under this section if the beneficiary were

13 an employee of such Secretary.

14 ‘‘(3) Each eligible beneficiary enrolled in an FEHBP

15 plan under this section shall be required to contribute the

16 amount that would be withheld from the pay of a similarly

17 situated Federal employee who is enrolled in the plan

18 under chapter 89 of title 5.

19 ‘‘(i) MANAGEMENT OF PARTICIPATION.—(1) The Di20 rector of the Office of Personnel Management shall man21 age the participation of eligible beneficiaries in FEHBP

22 plans under this section.

23 ‘‘(2) The Director and the administering Secretaries

24 shall ensure (whether through procedures, the establish25 ment of reserve funds, or other mechanisms) that inclu-
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1 sion of such participating eligible beneficiaries under chap2 ter 89 of title 5 will not have an adverse financial effect

3 on Federal employees and annuitants enrolled in health

4 benefits plans under such chapter.

5 ‘‘(j) REPORTING REQUIREMENTS.—(1) Not later

6 than November 1 each year, the administering Secretaries

7 and the Director of the Office of Personnel Management

8 shall jointly submit to Congress a report describing the

9 provision of health care services to eligible beneficiaries

10 who were enrolled in FEHBP plans under this section

11 during the preceding fiscal year. The report shall address

12 or contain the following:

13 ‘‘(A) The number of such eligible beneficiaries,

14 both in terms of total number and as a percentage

15 of all covered beneficiaries who are receiving health

16 care through the health care system of the uni17 formed services.

18 ‘‘(B) The extent to which such eligible bene19 ficiaries used the health care services available to

20 such beneficiaries under such plans.

21 ‘‘(C) The cost to such eligible beneficiaries of

22 health care under such plans.

23 ‘‘(D) The cost to the Department of Defense,

24 the Department of Transportation, the Department

25 of Health and Human Services, and any other de-
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1 partments and agencies of the Federal Government

2 of providing care to such eligible beneficiaries.

3 ‘‘(E) A comparison of the costs determined

4 under paragraphs (C) and (D) with the costs that

5 would otherwise have been incurred by the United

6 States and such eligible beneficiaries under alter7 native health care options available to the admin8 istering Secretaries.

9 ‘‘(F) The effects of the exercise of authority

10 under this section on the cost, access, and utilization

11 rates of other health care options under the health

12 care system of the uniformed services.

13 ‘‘(G) An assessment, as of the date of the re14 port, whether or not the health care option under

15 the TRICARE program known as TRICARE Stand16 ard offers medical care coverage that is substantially

17 similar to the medical care coverage offered under

18 the fee-for-service health benefits plan under the

19 Federal Employees Health Benefits program having

20 the most number of subscribers as of such date, and,

21 if not, whether or not that option is being modified

22 in order to offer such coverage.

23 ‘‘(2) Not later than 3 years after the date of enact24 ment of the Improved Military Medical Plan Act, the ad-
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1 ministering Secretaries shall jointly submit to Congress a

2 report setting forth—

3 ‘‘(A) the assessment of such Secretaries as to

4 the advisability of—

5 ‘‘(i) offering to eligible beneficiaries de6 scribed in subsection (b)(1) the health care op7 tion available under subsection (a) on a perma8 nent basis nationwide; or

9 ‘‘(ii) limiting the availability of that health

10 care option to eligible beneficiaries who are cur11 rently enrolled in an FEHBP plan as of the

12 date of the report;

13 ‘‘(B) the recommendation of such Secretaries

14 whether—

15 ‘‘(i) to expand the availability of the health

16 care option available under subsection (a) to

17 any member or former member of the uni18 formed services described in section 1074(b) of

19 this title, or any dependent of such member or

20 former member described in section 1076(b) of

21 this title, without regard to whether such mem22 ber or former member, or dependent, is entitled

23 to benefits under part A of title XVIII of the

24 Social Security Act; or
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1 ‘‘(ii) not to expand the availability of that

2 option in accordance with clause (i) because the

3 TRICARE Standard health care option offers

4 medical care coverage that is substantially simi5 lar to the medical care coverage offered under

6 the fee-for-service health benefits plan under

7 the Federal Employees Health Benefits pro8 gram having the most number of subscribers as

9 of the date of the report; and

10 ‘‘(C) the estimated costs of carrying out each

11 assessment under subparagraph (A) and the rec12 ommendation under subparagraph (B).

13 ‘‘(3)(A) Not later than 6 months after the submittal

14 of the report required by paragraph (2), the Comptroller

15 General shall submit to Congress an assessment of the

16 recommendation under subparagraph (B) of that para17 graph.

18 ‘‘(B) If the recommendation is not to expand the

19 availability of the option referred to in clause (i) of such

20 subparagraph (B) in accordance with that clause, the re21 view shall include an evaluation of the validity of any com22 parison made by the administering Secretaries for pur23 poses of clause (ii) of such subparagraph (B).’’.
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1 (2) The table of sections at the beginning of such

2 chapter is amended by inserting after the item relating

3 to section 1079a the following:

‘‘1079b. Health care coverage through Federal Employees Health Benefits program.’’.

4 (b) CONFORMING AMENDMENTS.—(1) Section 8905

5 of title 5, United States Code, is amended—

6 (A) by redesignating subsections (d), (e), and

7 (f) as subsections (e), (f), and (g), respectively; and

8 (B) by inserting after subsection (c) the follow9 ing new subsection (d):

10 ‘‘(d) An individual whom the administering Secretary

11 concerned determines is an eligible beneficiary under sub12 section (b) of section 1079b of title 10 may enroll in a

13 health benefits plan under this chapter in accordance with

14 the agreement entered into under subsection (a) of such

15 section between such Secretary and the Office and with

16 applicable regulations under this chapter.’’.

17 (2) Section 8906 of title 5, United States Code, is

18 amended—

19 (A) in subsection (b)—

20 (i) in paragraph (1), by striking ‘‘para21 graphs (2) and (3)’’ and inserting in lieu there22 of ‘‘paragraphs (2), (3), and (4)’’; and

23 (ii) by adding at the end the following new

24 paragraph:
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1 ‘‘(4) In the case of individuals who enroll in a health

2 plan under section 8905(d) of this title, the Government

3 contribution shall be determined under section 1079b(h)

4 of title 10.’’; and

5 (B) in subsection (g)—

6 (i) in paragraph (1), by striking ‘‘para7 graph (2)’’ and inserting in lieu thereof ‘‘para8 graphs (2) and (3)’’; and

9 (ii) by adding at the end the following new

10 paragraph:

11 ‘‘(3) The Government contribution described in sub12 section (b)(4) for individuals who enroll under section

13 8905(d) of this title shall be paid as provided in section

14 1079b(h) of title 10.’’.

15 (c) IMPLEMENTATION.—The administering Secretar16 ies shall begin to offer the health benefits option under

17 section 1079b(a) of title 10, United States Code (as added

18 by subsection (a)), not later than 6 months after the date

19 of enactment of this Act.

20 (d) AVAILABILITY OF FUNDS.—(1) There shall be

21 available to offer the health benefits option under section

22 1079b of title 10, United States Code (as added by sub23 section (a)), amounts as follows:

24 (A) $100,000,000 for fiscal year 1999.

25 (B) $125,000,000 for fiscal year 2000.
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1 (C) $150,000,000 for fiscal year 2001.

2 (D) $175,000,000 for fiscal year 2002.

3 (E) $200,000,000 for fiscal year 2003.

4 (2) Amounts available under paragraph (1) for a fis5 cal year for the purpose set forth in that paragraph shall

6 be derived from amounts authorized to be appropriated

7 to the Department of Defense, the Department of Trans8 portation, and the Department of Health and Human

9 Services, respectively, for such fiscal year for payment of

10 personnel costs.

11 (3) For each fiscal year set forth in paragraph (1),

12 the administering Secretaries shall determine the extent

13 to which the funds of their respective departments under

14 paragraph (2) shall be utilized for the purpose set forth

15 in paragraph (1) within the limitation for such fiscal year

16 specified in paragraph (1).

17 (e) PLAN FOR ENHANCEMENT OF TRICARE STAND18 ARD OPTION.—Not later than 6 months after the date of

19 enactment of this Act, the administering Secretaries shall

20 jointly submit to Congress a report that sets forth a plan

21 for any enhancements of the health care option under the

22 TRICARE program known as TRICARE Standard that

23 the administering Secretaries jointly consider necessary so

24 that the medical care coverage offered under that option

25 is substantially similar to the medical care coverage of-
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1 fered under the fee-for-service health benefits plan under

2 the Federal Employees Health Benefits program under

3 chapter 89 of title 5, United States Code, that has the

4 most number of subscribers as of the date of the report.

5 (f) DEFINITIONS.—In this section:

6 (1) The term ‘‘administering Secretaries’’ has

7 the meaning given that term in section 1072(3) of

8 title 10, United States Code.

9 (2) The term ‘‘TRICARE program’’ has the

10 meaning given that term in section 1072(7) of title

11 10, United States Code.

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