II

106TH CONGRESS

2D SESSION S. 2087

To amend title 10, United States Code, to improve access to benefits under

the TRICARE program; to extend and improve certain demonstration

programs under the Defense Health Program; and for other purposes.

IN THE SENATE OF THE UNITED STATES

FEBRUARY 23, 2000

Mr. WARNER (for himself, Mr. LOTT, Mr. LEVIN, Mr. DASCHLE, Mr. HUTCHINSON, Mr. CLELAND, Mr. THURMOND, Mr. KENNEDY, Mr. INHOFE, Mr.

SANTORUM, Ms. SNOWE, Mr. ROBERTS, Mr. ALLARD, Mrs. HUTCHISON,

Mr. LIEBERMAN, Ms. LANDRIEU, Mr. REED, Mr. CRAPO, Mr. INOUYE,

Mrs. LINCOLN, and Mr. KERRY) 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 improve access

to benefits under the TRICARE program; to extend and

improve certain demonstration programs under the Defense Health Program; 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 ‘‘Military Health Care

5 Improvements Act of 2000’’.
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1 TITLE I—DEMONSTRATION

2 PROGRAMS

3 Subtitle A—TRICARE Demonstra4 tion Programs for Seniors

5 SEC. 101. EXTENSION OF TRICARE SENIOR SUPPLEMENT

6 PROGRAM.

7 Section 722(a)(2) of the Strom Thurmond National

8 Defense Authorization Act for Fiscal Year 1999 (Public

9 Law 105–261; 112 Stat. 2065; 10 U.S.C. 1073 note) is

10 amended by striking ‘‘December 31, 2002’’ and inserting

11 ‘‘December 31, 2005’’.

12 SEC. 102. TRICARE SENIOR PRIME.

13 (a) EXTENSION OF DEMONSTRATION PROGRAM.—

14 Paragraph (4) of section 1896(b) of the Social Security

15 Act (42 U.S.C. 1395ggg(b)) is amended by striking ‘‘3-

16 year period beginning on January 1, 1998’’ and inserting

17 ‘‘period beginning on January 1, 1998, and ending on De18 cember 31, 2005’’.

19 (b) ADDITION OF MAJOR MEDICAL CENTERS.—

20 Paragraph (1)(A) of such section 1895(b) is amended by

21 striking ‘‘in a military treatment facility’’ and inserting

22 ‘‘in a Department of Defense medical center considered

23 by the Secretary to be a major medical center, in any other

24 military treatment facility,’’.
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1 (c) DESIGNATION OF ADDITIONAL SITES.—Para2 graph (2) of such section 1896(b) is amended to read as

3 follows:

4 ‘‘(2) DESIGNATION OF SITES.—

5 ‘‘(A) IN GENERAL.—The project estab6 lished under this section shall be conducted at

7 sites designated jointly by the administering

8 Secretaries after review of all TRICARE re9 gions.

10 ‘‘(B) SPECIFIC SITES.—The sites for the

11 project shall include the 6 sites designated in

12 accordance with subparagraph (A) before the

13 date of the enactment of the National Defense

14 Authorization Act for Fiscal Year 2001 and the

15 major medical centers designated after such

16 date in accordance with that subparagraph.’’.

17 Subtitle B—Other Demonstration

18 Programs

19 SEC. 106. COVERAGE BY FEDERAL EMPLOYEES HEALTH

20 BENEFITS PROGRAM.

21 (a) EXTENSION OF COVERAGE FOR RETIREES OVER

22 AGE 65.—(1) Section 1108 of title 10, United States

23 Code, is amended by adding at the end the following:

24 ‘‘(m) EXTENSION OF COVERAGE FOR RETIREES

25 OVER AGE 65.—(1) Eligible beneficiaries referred to in
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1 subsection (b)(1) who will be at least 65 years of age on

2 December 31, 2002, shall be permitted to enroll, or to ex3 tend a previous enrollment entered into under subsection

4 (d)(2), during a period of open enrollment for the year

5 2003 (conducted in the fall of 2002).

6 ‘‘(2) Subject to paragraphs (2) and (3) of subsection

7 (f), the period of enrollment, or extension of enrollment,

8 of an eligible beneficiary under paragraph (1) shall be two

9 years unless the beneficiary disenrolls before the termi10 nation of the demonstration project.

11 ‘‘(3) The agreement under subsection (a) shall pro12 vide for continuation of the demonstration project for a

13 total of five contract years under the Federal Employees

14 Health Benefits program for eligible beneficiaries referred

15 to in paragraph (1).’’.

16 (2) Subsection (d) of such section is amended—

17 (A) in paragraph (1), by striking ‘‘three con18 tract years’’ and inserting ‘‘six contract years’’; and

19 (B) in paragraph (2), by striking ‘‘December

20 31, 2002’’ in the second sentence and inserting ‘‘De21 cember 31, 2005’’.

22 (3) Subsection (f)(1) of such section is amended by

23 adding at the end the following: ‘‘A beneficiary may not

24 extend the enrollment unless eligible to do so under sub25 section (m)(1).’’.
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1 (b) ADDITIONAL AREAS OF COVERAGE.—Subsection

2 (c) of such section is amended—

3 (1) by striking ‘‘, but not more than ten,’’; and

4 (2) by striking the third sentence and inserting

5 the following: ‘‘In establishing the areas, the Sec6 retary and Director shall include an area that in7 cludes the catchment area of one or more military

8 medical treatment facilities, an area that is not lo9 cated in the catchment area of a military medical

10 treatment facility, an area in which there is a Medi11 care Subvention Demonstration project area under

12 section 1896 of title XVIII of the Social Security

13 Act (42 U.S.C. 1395ggg), and one area for each

14 TRICARE region. Each area selected after the date

15 of the enactment of the National Defense Authoriza16 tion Act for Fiscal Year 2001 shall be an area that

17 is not located in the catchment area of a military

18 medical treatment facility.’’.

19 SEC. 107. IMPLEMENTATION OF REDESIGNED PHARMACY

20 SYSTEM.

21 (a) ENROLLMENT FEE AND DEDUCTIBLES RE22 QUIRED.—Subsection (b) of section 723 of the Strom

23 Thurmond National Defense Authorization Act for Fiscal

24 Year 1999 (Public Law 105–261; 112 Stat. 2068; 10

25 U.S.C. 1073 note) is amended to read as follows:
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1 ‘‘(b) ENROLLMENT FEES, DEDUCTIBLES, AND

2 OTHER CHARGES.—(1) The Secretary may require each

3 eligible individual described in subsection (e) who partici4 pates in the redesigned pharmacy system to pay an enroll5 ment fee. The Secretary shall ensure that any such enroll6 ment fee required after December 31, 2000, is lower than

7 the enrollment fee charged under this subsection on such

8 date.

9 ‘‘(2) The Secretary may also impose one or more

10 cost-sharing requirements for each individual referred to

11 in paragraph (1) for benefits under the redesigned phar12 macy system as follows:

13 ‘‘(A) An annual deductible requirement for each

14 such individual.

15 ‘‘(B) Any premiums, copayments, or other

16 charges that the Secretary would otherwise collect

17 from individuals similar to such individual.’’.

18 (b) PERIODIC PAYMENT OF PREMIUMS.—Subsection

19 (b) of such section is further amended by adding at the

20 end the following:

21 ‘‘(2) An individual may elect to pay a premium

22 charged under this subsection on a monthly or quarterly

23 basis.’’.

24 (c) EFFECTIVE DATE.—The amendments made by

25 this section shall take effect on January 1, 2001, and shall
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1 apply with respect to participation in the redesigned phar2 macy system under section 723 of Public Law 105–261

3 for months beginning on or after that date.

4 TITLE II—TRICARE PRIME

5 PERMANENT AUTHORITIES

6 SEC. 201. ADDITIONAL BENEFICIARIES UNDER TRICARE

7 PRIME REMOTE PROGRAM IN CONUS.

8 (a) COVERAGE OF OTHER UNIFORMED SERVICES.—

9 (1) Section 1074(c) of title 10, United States Code, is

10 amended—

11 (A) by striking ‘‘armed forces’’ each place it ap12 pears, except in paragraph (3)(A), and inserting

13 ‘‘uniformed services’’;

14 (B) in paragraph (1), by inserting after ‘‘mili15 tary department’’ in the first sentence the following:

16 ‘‘, the Department of Transportation (with respect

17 to the Coast Guard when it is not operating as a

18 service in the Navy), or the Department of Health

19 and Human Services (with respect to the National

20 Oceanic and Atmospheric Administration and the

21 Public Health Service)’’;

22 (C) in paragraph (2), by adding at the end the

23 following:
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1 ‘‘(C) The Secretary of Defense shall consult

2 with the other administering Secretaries in the ad3 ministration of this paragraph.’’; and

4 (D) in paragraph (3)(A), by striking ‘‘The Sec5 retary of Defense may not require a member of the

6 armed forces described in subparagraph (B)’’ and

7 inserting ‘‘A member of the uniformed services de8 scribed in subparagraph (B) may not be required’’.

9 (2)(A) Subsections (b), (c), and (d)(3) of section 731

10 of the National Defense Authorization Act for Fiscal Year

11 1998 (Public Law 105–85; 111 Stat. 1811; 10 U.S.C.

12 1074 note) are amended by striking ‘‘Armed Forces’’ and

13 inserting ‘‘uniformed services’’.

14 (B) Subsection (b) of such section is further amended

15 by adding at the end the following:

16 ‘‘(4) The Secretary of Defense shall consult with the

17 other administering Secretaries in the administration of

18 this subsection.’’.

19 (C) Subsection (f) of such section is amended by add20 ing at the end the following:

21 ‘‘(3) The terms ‘uniformed services’ and ‘ad22 ministering Secretaries’ have the meanings given

23 those terms in section 1072 of title 10, United

24 States Code.’’.
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1 (3) Section 706(b) of the National Defense Author2 ization Act for Fiscal Year 2000 (Public Law 106–65; 113

3 Stat. 684) is amended by striking ‘‘Armed Forces’’ and

4 inserting ‘‘uniformed services (as defined in section

5 1072(1) of title 10, United States Code)’’.

6 (b) COVERAGE OF IMMEDIATE FAMILY.—(1) Section

7 1079 of title 10, United States Code, is amended by add8 ing at the end the following:

9 ‘‘(p)(1) Subject to such exceptions as the Secretary

10 of Defense considers necessary, coverage for medical care

11 under this section for the dependents referred to in sub12 section (a) of a member of the uniformed services referred

13 to in section 1074(c)(3) of this title who are residing with

14 the member, and standards with respect to timely access

15 to such care, shall be comparable to coverage for medical

16 care and standards for timely access to such care under

17 the managed care option of the TRICARE program known

18 as TRICARE Prime.

19 ‘‘(2) The Secretary of Defense shall enter into ar20 rangements with contractors under the TRICARE pro21 gram or with other appropriate contractors for the timely

22 and efficient processing of claims under this subsection.

23 ‘‘(3) The Secretary of Defense shall consult with the

24 other administering Secretaries in the administration of

25 this subsection.’’.
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1 (2) Section 731(b) of the National Defense Author2 ization Act for Fiscal Year 1998 (Public Law 105–85; 111

3 Stat. 1811; 10 U.S.C. 1074 note) is amended—

4 (A) in paragraph (1), by adding at the end the

5 following: ‘‘A dependent of the member, as described

6 in subparagraph (A), (D), or (I) of section 1072(2)

7 of title 10, United States Code, who is residing with

8 the member shall have the same entitlement to care

9 and to waiver of charges as the member.’’; and

10 (B) in paragraph (2), by inserting ‘‘or depend11 ent of the member, as the case may be,’’ after ‘‘(2)

12 A member’’.

13 (c) EFFECTIVE DATE.—(1) The amendments made

14 by subsection (a)(2), with respect to members of the uni15 formed services, and the amendments made by subsection

16 (b)(2), with respect to dependents of members, shall take

17 effect on the date of the enactment of this Act and shall

18 expire with respect to a member or the dependents of a

19 member, respectively, on the later of the following:

20 (A) The date that is one year after the date of

21 the enactment of this Act.

22 (B) The date on which the amendments sub23 section (a)(1) or (b)(1) apply with respect to the

24 coverage of medical care for and provision of such

25 care to the member or dependents, respectively.
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1 (2) Section 731(b)(3) of Public Law 105–85 does not

2 apply to a member of the Coast Guard, the National Oce3 anic and Atmospheric Administration, or the Commis4 sioned Corps of the Public Health Service, or to a depend5 ent of a member of a uniformed service.

6 SEC. 202. ELIMINATION OF COPAYMENTS FOR IMMEDIATE

7 FAMILY.

8 (a) NO COPAYMENT FOR IMMEDIATE FAMILY.—Sec9 tion 1097a of title 10, United States Code, is amended—

10 (1) by redesignating subsection (e) as sub11 section (f); and

12 (2) by inserting after subsection (d) the fol13 lowing new subsection (e):

14 ‘‘(e) NO COPAYMENT FOR IMMEDIATE FAMILY.—No

15 copayment shall be charged a member for care provided

16 under TRICARE Prime to a dependent of a member of

17 the uniformed services described in subparagraph (A),

18 (D), or (I) of section 1072 of this title.’’.

19 (b) EFFECTIVE DATE.—The amendments made by

20 subsection (a) shall take effect on October 1, 2000, and

21 shall apply with respect to care provided on or after that

22 date.
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1 SEC. 203. IMPROVEMENT IN BUSINESS PRACTICES IN THE

2 ADMINISTRATION OF THE TRICARE PRO3 GRAM.

4 (a) REQUIREMENT.—Not later than October 1, 2001,

5 the Secretary of Defense shall take actions that the Sec6 retary considers appropriate to improve the business prac7 tices used in administering the access of eligible persons

8 to health care services through the TRICARE program

9 under chapter 55 of title 10, United States Code, includ10 ing the practices relating to the following:

11 (1) The availability and scheduling of appoint12 ments.

13 (2) The filing, processing, and payment of

14 claims.

15 (3) Public relations efforts that are focused on

16 outreach to eligible persons.

17 (4) The continuation of enrollments without ex18 piration.

19 (5) The portability of enrollments nationwide.

20 (b) CONSULTATION.—The Secretary of Defense shall

21 consult with the other administering Secretaries in the de22 velopment of the actions to be taken under subsection (a).

23 (c) REPORT.—Not later than March 15, 2001, the

24 Secretary of Defense shall submit to the Committees on

25 Armed Services of the Senate and House of Representa-
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1 tives a report on the actions to be taken under subsection

2 (a).

3 (d) DEFINITIONS.—In this section the terms ‘‘admin4 istering Secretaries’’ and ‘‘TRICARE program’’ shall have

5 the meanings given such terms in section 1072 of title 10,

6 United States Code.

7 TITLE III—OTHER DEFENSE

8 HEALTH PROGRAM MATTERS

9 SEC. 301. NATIONAL MAIL ORDER PHARMACY PROGRAM.

10 (a) ESTABLISHMENT.—(1) Chapter 55 of title 10,

11 United States Code, is amended by adding at the end the

12 following:

13 ‘‘§ 1110. Mail order pharmaceuticals

14 ‘‘(a) REQUIREMENT.—(1) The Secretary of Defense

15 shall carry out a program that permits eligible persons de16 scribed in subsection (b) to obtain prescription pharma17 ceuticals by mail.

18 ‘‘(b) ELIGIBLE PERSONS.—A person is eligible to ob19 tain pharmaceuticals under the program if the person—

20 ‘‘(1) is 65 years of age or older;

21 ‘‘(2) would be eligible for medical care under a

22 contract for medical care entered into under section

23 1086 of this title except for the operation of sub24 section (d)(1) of such section; and
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1 ‘‘(3) is enrolled in the supplemental medical in2 surance program under part B of title XVIII of the

3 Social Security Act (42 U.S.C. 1395j et seq.).

4 ‘‘(c) PHARMACEUTICALS OFFERED.—The Secretary

5 of Defense shall determine the pharmaceuticals that may

6 be obtained by eligible persons under the program.

7 ‘‘(d) ANNUAL DEDUCTIBLE.—The Secretary of De8 fense may impose an annual deductible requirement for

9 each person obtaining pharmaceuticals under the pro10 gram. The amount of any annual deductible imposed

11 under this subsection may not exceed $150.

12 ‘‘(e) CONSULTATION REQUIREMENT.—The Secretary

13 of Defense shall consult with the other administering Sec14 retaries in carrying out the program, including in the de15 termining of the pharmaceuticals that may be obtained

16 under the program.’’.

17 (2) The table of sections at the beginning of such

18 chapter is amended by adding at the end the following:

‘‘1110. Mail order pharmaceuticals.’’.

19 (b) COMMENCEMENT OF PROGRAM.—The program

20 required by section 1110 of title 10, United States Code

21 (as added by subsection (a)), shall commence not later

22 than the first day of the first month that begins on or

23 after the date that is 180 days after the date of the enact24 ment of this Act.
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1 (c) RELATIONSHIP TO DEMONSTRATION PROJECT.—

2 The program carried out under section 1110 of title 10,

3 United States Code (as added by subsection (a)), is in ad4 dition to the demonstration project carried out under sec5 tion 702 of the National Defense Authorization Act for

6 Fiscal Year 1993 (Public Law 102–484; 106 Stat. 2431;

7 10 U.S.C. 1079 note).

8 SEC. 302. PROVISION OF DOMICILIARY AND CUSTODIAL

9 CARE FOR CHAMPUS BENEFICIARIES.

10 (a) CONTINUATION OF CARE FOR CERTAIN

11 CHAMPUS BENEFICIARIES.—Subsection (a)(3) of sec12 tion 703 of the National Defense Authorization Act for

13 Fiscal Year 2000 (Public Law 106–65; 113 Stat. 682; 10

14 U.S.C. 1077 note) is amended to read as follows:

15 ‘‘(3) As used in this section, the term ‘eligible bene16 ficiary’ means the following:

17 ‘‘(A) A covered beneficiary (as that term is de18 fined in section 1072 of title 10, United States

19 Code) who, before the effective date of final regula20 tions to implement the individual case management

21 program authorized by section 1079(a)(17) of such

22 title was provided domiciliary or custodial care serv23 ices for which the Secretary provided payment.

24 ‘‘(B) A person who formerly was an eligible

25 beneficiary under subparagraph (A) and is enrolled
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1 in the TRICARE Senior Prime plan under the medi2 care subvention demonstration project for military

3 retirees carried out under section 1896 of the Social

4 Security Act (42 U.S.C. 1395ggg).’’.

5 (b) COST LIMITATION.—Such section 703 is further

6 amended by adding at the end the following:

7 ‘‘(e) COST LIMITATION.—The total amount expended

8 for services provided under subsection (a) for eligible bene9 ficiaries may not exceed $100,000,000 in fiscal year 2000

10 or any fiscal year thereafter.’’.

11 SEC. 303. STUDIES OF ACCRUAL FINANCING FOR HEALTH

12 CARE FOR MILITARY RETIREES.

13 (a) STUDIES REQUIRED.—The Secretary of Defense

14 shall carry out two studies to assess the feasibility and

15 desirability of financing the military health care program

16 for retirees of the uniformed services on an accrual basis.

17 (b) SOURCES OF STUDIES.—The Secretary shall pro18 vide for—

19 (1) one of the studies under subsection (a) to

20 be conducted by one or more Department of Defense

21 organizations designated by the Secretary; and

22 (2) the other study to be conducted by an orga23 nization that is independent of the Department of

24 Defense and has expertise in financial programs and

25 health care.
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1 (c) REPORTS.—(1) The Secretary shall provide for

2 the submission of a final report on each study to the Sec3 retary within such time as the Secretary determines nec4 essary to satisfy the requirement in paragraph (2).

5 (2) The Secretary shall transmit the final reports on

6 the studies to Congress not later than February 8, 2001.

7 The Secretary may include in the transmittal any com8 ments on the reports or on the matters studied that the

9 Secretary considers appropriate.

10 TITLE IV—JOINT DEPARTMENT

11 OF DEFENSE AND DEPART12 MENT OF VETERANS AFFAIRS

13 INITIATIVES

14 SEC. 401. TRACKING PATIENT SAFETY IN MILITARY AND

15 VETERANS HEALTH CARE SYSTEMS.

16 (a) CENTRALIZED TRACKING PROCESS.—The Sec17 retary of Defense and the Secretary of Veterans Affairs

18 shall jointly prescribe a centralized process for the report19 ing, compiling, and analysis of errors in the provision of

20 health care under the Defense Health Program and the

21 Department of Veterans Affairs health care system that

22 endanger patients beyond the normal risks associated with

23 the care and treatment of the patients.

24 (b) SAFETY INDICATORS, ET CETERA.—The process

25 shall include such indicators, standards, and protocols as
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1 the Secretary of Defense and the Secretary of Veterans

2 Affairs consider necessary for the establishment and ad3 ministration of an effective process.

4 SEC. 402. PHARMACEUTICAL IDENTIFICATION TECH5 NOLOGY.

6 (a) BAR CODE IDENTIFICATION TECHNOLOGY.—The

7 Secretary of Defense and the Secretary of Veterans Af8 fairs shall jointly develop a system for the use of bar codes

9 for the identification of pharmaceuticals.

10 (b) USE IN NATIONAL MAIL ORDER PHARMA11 CEUTICALS DEMONSTRATION PROJECT.—The Secretary

12 of Defense, in consultation with the Secretary of Veterans

13 Affairs, shall experiment with the use of bar code identi14 fication of pharmaceuticals in the administration of the

15 mail order pharmaceutical demonstration project being

16 carried out under section 702 of the National Defense Au17 thorization Act for Fiscal Year 1993 (Public Law 102–

18 484; 106 Stat. 2431; 10 U.S.C. 1079 note).

Æ