I

106TH CONGRESS

1ST SESSION H. R. 1547

To amend title 10, United States Code, to make certain improvements with

respect to the TRICARE program.

IN THE HOUSE OF REPRESENTATIVES

APRIL 22, 1999

Mr. THORNBERRY introduced the following bill; which was referred to the

Committee on Armed Services

A BILL

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

improvements with respect to the TRICARE program.

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

3 SECTION. 1. IMPROVEMENT OF TRICARE PROGRAM.

4 (a) IMPROVEMENT OF TRICARE PROGRAM.—Chap5 ter 55 of title 10, United States Code, is amended by in6 serting after section 1097a the following new section:
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1 ‘‘§ 1097b. TRICARE: comparability of benefits with

2 benefits under Federal Employees Health

3 Benefits program; other requirements

4 and authorities

5 ‘‘(a) COMPARABILITY OF BENEFITS.—The Secretary

6 of Defense shall, to the maximum extent practicable, en7 sure that the health care coverage available through the

8 TRICARE program is substantially similar to the health

9 care coverage available under similar health benefits plans

10 offered under the Federal Employees Health Benefits pro11 gram established under chapter 89 of title 5.

12 ‘‘(b) PORTABILITY OF BENEFITS.—The Secretary of

13 Defense shall provide that any covered beneficiary enrolled

14 in the TRICARE program may receive benefits under that

15 program at facilities that provide benefits under that pro16 gram throughout the various regions of that program.

17 ‘‘(c) PATIENT MANAGEMENT.—(1) The Secretary of

18 Defense shall, to the maximum extent practicable, mini19 mize the authorization or certification requirements im20 posed upon covered beneficiaries under the TRICARE

21 program as a condition of access to benefits under that

22 program.

23 ‘‘(2) The Secretary of Defense shall implement, with

24 respect the first two contracts awarded after the date of

25 the enactment of this section to provide managed care sup26 port under the TRICARE program, redesigned procedures
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1 for payment and processing of claims under such program.

2 Such procedures shall incorporate best industry practices

3 for processing claims for health care services in a sim4 plified and expedited manner and shall include electronic

5 claims processing.

6 ‘‘(d) AUTHORITY FOR CERTAIN THIRD-PARTY COL7 LECTIONS.—(1) A medical treatment facility of the uni8 formed services under the TRICARE program may collect

9 from a third-party payer the reasonable charges for health

10 care services described in paragraph (2) that are incurred

11 by the facility on behalf of a covered beneficiary under

12 that program to the extent that the beneficiary would be

13 eligible to receive reimbursement or indemnification from

14 the third-party payer if the beneficiary were to incur such

15 charges on the beneficiary’s own behalf.

16 ‘‘(2) The reasonable charges described in this para17 graph are reasonable charges for services or care covered

18 by the medicare program under title XVIII of the Social

19 Security Act.

20 ‘‘(3) The collection of charges, and the utilization of

21 amounts collected, under this subsection shall be subject

22 to the provisions of section 1095 of this title. The term

23 ‘reasonable costs’, as used in that section shall be deemed

24 for purposes of the application of that section to this sub-
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1 section to refer to the reasonable charges described in

2 paragraph (2).

3 ‘‘(e) CONSULTATION.—The Secretary of Defense

4 shall carry out any actions under this section after con5 sultation with the other administering Secretaries.’’.

6 (b) CLERICAL AMENDMENT.—The table of sections

7 at the beginning of chapter 55 of such title is amended

8 by inserting after the item relating to section 1097a the

9 following new item:

‘‘1097b. TRICARE: comparability of benefits with benefits under Federal Employees Health Benefits program; other requirements and authorities.’’.

10 (c) REPORT ON IMPLEMENTATION.—(1) Not later

11 than 6 months after the date of the enactment of this Act,

12 the Secretary of Defense, in consultation with the other

13 administering Secretaries, shall submit to Congress a re14 port assessing the effects of the implementation of the re15 quirements and authorities set forth in section 1097b of

16 title 10, United States Code (as added by subsection (a)).

17 (2) The report shall include the following:

18 (A) An assessment of the cost of the implemen19 tation of such requirements and authorities.

20 (B) An assessment whether or not the imple21 mentation of any such requirements and authorities

22 will result in the utilization by the TRICARE pro23 gram of the best industry practices with respect to
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1 the matters covered by such requirements and au2 thorities.

3 (3) In this subsection, the term ‘‘administering Secre4 taries’’ has the meaning given that term in section

5 1072(3) of title 10, United States Code.

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