H. R. 1119—187
(2) by inserting after subsection (c) the following new sub-
section:
‘‘(d)(1) Notwithstanding any law regarding the licensure of
health care providers, a health-care professional described in para-
graph (2) may practice the health profession or professions of the
health-care professional in any State, the District of Columbia,
or 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.’’.
SEC. 738. STANDARD FORM AND REQUIREMENTS REGARDING CLAIMS
FOR PAYMENT FOR SERVICES.
(a) CLARIFICATION OF EXISTING REQUIREMENTS.—Section 1106
of title 10, United States Code, is amended to read as follows:
‘‘§ 1106. Submittal of claims: standard form; time limits
‘‘(a) STANDARD FORM.—The Secretary of Defense, after consulta-
tion 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.’’.
(b) CLERICAL AMENDMENT.—The table of sections at the begin-
ning of chapter 55 of title 10, United States Code, is amended
by striking out the item relating to section 1106 and inserting
in lieu thereof the following new item:
‘‘1106. Submittal of claims: standard form; time limits.’’.
SEC. 739. CHIROPRACTIC HEALTH CARE DEMONSTRATION PROGRAM.
(a) TWO-YEAR EXTENSION.—Subsection (b) of section 731 of
the National Defense Authorization Act for Fiscal Year 1995 (Public
Law 103–337; 10 U.S.C. 1092 note) is amended by striking out
‘‘1997’’ and inserting in lieu thereof ‘‘1999’’.
(b) EXPANSION TO AT LEAST THREE ADDITIONAL TREATMENT
FACILITIES.—Subsection (a)(2)(A) of such section is amended by
striking out ‘‘not less than 10’’ and inserting in lieu thereof ‘‘the
National Naval Medical Center, the Walter Reed Army Medical
Center, and not less than 11 other’’.
(c) REPORTS.—Subsection (c) of such section is amended—
(1) by striking paragraph (3); and
(2) by adding at the end the following new paragraphs:
‘‘(3) Not later than January 30, 1998, the Secretary of Defense
shall submit to the Committee on Armed Services of the Senate
and the Committee on National Security of the House of Representa-
tives a report that identifies the additional treatment facilities
designated to furnish chiropractic care under the program that
were not so designated before the report required by paragraph
H. R. 1119—188
(1) was prepared, together with the plan for the conduct of the
program at the additional treatment facilities.
‘‘(4) Not later than May 1, 1998, the Secretary of Defense
shall modify the plan for evaluating the program submitted pursu-
ant to paragraph (2) in order to provide for the evaluation of
the program at all of the designated treatment facilities under
the program, including the treatment facilities referred to in para-
graph (3).
‘‘(5) Not later than May 1, 2000, the Secretary shall submit
to the committees referred to in paragraph (3) a final report in
accordance with the plan submitted pursuant to paragraph (2).’’.
Subtitle E—Other Matters
SEC. 741. CONTINUED ADMISSION OF CIVILIANS AS STUDENTS IN
PHYSICIAN ASSISTANT TRAINING PROGRAM OF ARMY
MEDICAL DEPARTMENT.
(a) CIVILIAN ATTENDANCE.—(1) Chapter 407 of title 10, United
States Code, is amended by adding at the end the following new
section:
‘‘§ 4416. Academy of Health Sciences: admission of civilians
in physician assistant training program
‘‘(a) IN GENERAL.—The Secretary of the Army may, pursuant
to an agreement entered into with an accredited institution of
higher education—
‘‘(1) permit students of the institution to attend the didactic
portion of the physician assistant training program conducted
by the Army Medical Department at the Academy of Health
Sciences at Fort Sam Houston, Texas; and
‘‘(2) accept from the institution academic services to support
the physician assistant training program at the Academy.
‘‘(b) AGREEMENT FOR EXCHANGE OF SERVICES.—An agreement
entered into with an institution of higher education under this
section shall require the institution, in exchange for services pro-
vided under paragraph (1) of subsection (a), to provide academic
services described in paragraph (2) of such subsection that the
Secretary and authorized representatives of the institution consider
appropriate.
‘‘(c) SELECTION OF STUDENTS.—In consultation with the author-
ized representatives of the institution of higher education concerned,
the Secretary shall prescribe the qualifications and methods of
selection for students of the institution to receive instruction at
the Academy under this section. The qualifications shall be com-
parable to those generally required for admission to the physician
assistant training program at the Academy.
‘‘(d) RULES OF ATTENDANCE.—Except as the Secretary deter-
mines necessary, a student who receives instruction at the Academy
under this section shall be subject to the same regulations governing
attendance, discipline, discharge, and dismissal as apply to other
persons attending the Academy.
‘‘(e) LIMITATIONS.—The Secretary shall ensure the following:
‘‘(1) That the Army Medical Department, in carrying out
an agreement under this section, does not incur costs in excess
of the costs that the department would incur to obtain, by
means other than the agreement, academic services that are
H. R. 1119—189
comparable to those provided by the institution pursuant to
the agreement.
‘‘(2) That attendance of civilian students at the Academy
under this section does not cause a decrease in the number
of members of the armed forces enrolled in the physician assist-
ant training program at the Academy.
‘‘(f) ANNUAL REPORT.—(1) Each year, the Secretary shall submit
to Congress a report on the exchange of services under this section
during the year. The report shall contain the following:
‘‘(A) The number of civilian students who receive instruc-
tion at the Academy under this section.
‘‘(B) An assessment of the benefits derived by the United
States.
‘‘(2) Reports are required under paragraph (1) only for years
during which an agreement is in effect under this section.’’.
(2) The table of sections at the beginning of such chapter
is amended by adding at the end the following new item:
‘‘4416. Academy of Health Sciences: admission of civilians in physician assistant
training program.’’.
(b) EFFECT ON EXISTING DEMONSTRATION PROGRAM.—An agree-
ment entered into under the demonstration program for the admis-
sion of civilians as physician assistant students at the Academy
of Health Sciences, Fort Sam Houston, Texas, established pursuant
to section 732 of the National Defense Authorization Act for Fiscal
Year 1995 (Public Law 103–337; 108 Stat. 2810) shall be treated
as an agreement entered into under section 4416 of title 10, United
States Code (as added by subsection (a)). The agreement may be
extended in such manner and for such period as the parties to
the agreement consider appropriate consistent with section 4416.
SEC. 742. PAYMENT FOR EMERGENCY HEALTH CARE OVERSEAS FOR
MILITARY AND CIVILIAN PERSONNEL OF THE ON-SITE
INSPECTION AGENCY.
(a) PAYMENT OF COSTS.—The Secretary of Defense may pay
the costs of any emergency health care that—
(1) is needed by a member of the Armed Forces, civilian
employee of the Department of Defense, or civilian employee
of a contractor operating under a contract with the Department
of Defense while the member or employee is performing tem-
porary or permanent duty with the On-Site Inspection Agency
outside the United States; and
(2) is furnished to such person during fiscal year 1998
by a source outside the United States.
(b) FUNDING.—Funds authorized to be appropriated for the
expenses of the On-Site Inspection Agency for fiscal year 1998
by this Act shall be available to cover payments for emergency
health care provided under subsection (a).
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:
H. R. 1119—190
(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 independ-
ently; 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 contract-
ing or grievance procedures applicable under the agree-
ment;
(C) the types of care to be provided to eligible individ-
uals under the agreement, including the cost to the Depart-
ment 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.
(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 agree-
ment is in force;
(B) the nature of that arrangement upon termination
of the agreement; and
(C) any requirement for reimbursement of the Sec-
retary by the Hospital as a result of the arrangement
upon termination of the agreement.
(4) The amount of the funds made available under sub-
section (c) that the Secretary will contribute for the construction
and equipping of the facility.
(5) Any conditions or restrictions relating to the construc-
tion, equipping, or use of the facility.
(c) AVAILABILITY OF FUNDS FOR CONSTRUCTION AND EQUIPPING
OF FACILITY.—(1) Of the amount authorized to be appropriated
H. R. 1119—191
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 author-
ized 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 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 mainte-
nance 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 Sec-
retary 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.
H. R. 1119—192
SEC. 744. DISCLOSURES OF CAUTIONARY INFORMATION ON PRESCRIP-
TION 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 regula-
tions to require each source described in subsection (d) that dis-
penses a prescription medication to a beneficiary under chapter
55 of such title to include with the medication the written caution-
ary 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 pos-
sible 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 fol-
lowing:
(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 admin-
istering 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. COMPETITIVE PROCUREMENT OF CERTAIN OPHTHALMIC
SERVICES.
(a) COMPETITIVE
PROCUREMENT
REQUIRED.—Beginning not
later than October 1, 1998, the Secretary of Defense shall competi-
tively procure from private-sector sources, or other sources outside
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 bene-
ficiaries 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 Septem-
ber 30, 1998.
H. R. 1119—193
SEC. 746. COMPTROLLER GENERAL STUDY OF ADEQUACY AND EFFECT
OF MAXIMUM ALLOWABLE CHARGES FOR PHYSICIANS
UNDER CHAMPUS.
(a) STUDY REQUIRED.—The Comptroller General shall conduct
a study regarding the adequacy of the maximum allowable charges
for physicians established under the Civilian Health and Medical
Program of the Uniformed Services (CHAMPUS) and the effect
of such charges on the participation of physicians in CHAMPUS.
The study shall include an evaluation of the following:
(1) The methodology used by the Secretary of Defense
to establish maximum allowable charges for physicians under
CHAMPUS, and whether such methodology conforms to the
requirements of section 1079(h) of title 10, United States Code.
(2) The differences between the established charges under
CHAMPUS and reimbursement rates for similar services under
title XVIII of the Social Security Act and other health care
programs.
(3) The basis for physician complaints that the CHAMPUS
established charges are too low.
(4) The difficultly of CHAMPUS in ensuring physician
compliance with the CHAMPUS established charges in the
absence of legal mechanisms to enforce compliance, and the
effect of noncompliance on patient out-of-pocket expenses.
(5) The effect of the established charges under CHAMPUS
on the participation of physicians in CHAMPUS, and the extent
and success of Department of Defense efforts to increase physi-
cian participation in areas with low participation rates.
(b) SUBMISSION OF REPORT.—Not later than March 1, 1998,
the Comptroller General shall submit to Congress a report contain-
ing the results of the study required by subsection (a).
SEC. 747. COMPTROLLER GENERAL STUDY OF DEPARTMENT OF
DEFENSE PHARMACY PROGRAMS.
(a) STUDY.—Not later than March 31, 1998, the Comptroller
General shall submit to Congress a study evaluating the pharmacy
programs of the Department of Defense. The study shall examine
the impact of such pharmacy programs on the aggregate cost,
quality, and accessibility of health care provided to covered bene-
ficiaries under chapter 55 of title 10, United States Code, and
shall include an examination of the following:
(1) The merits and feasibility of establishing a uniform
formulary for military treatment facility pharmacies and
civilian contractor pharmacy benefit administrators.
(2) The reasons that military treatment facilities deny cov-
ered beneficiaries access to pharmacy care and shift such bene-
ficiaries to other sources of pharmacy care.
(3) The merits and feasibility of using private sector cost
control mechanisms implemented by authorized civilian con-
tractors in the Department of Defense medical programs, and
the existence of any barriers to the use of such mechanisms,
including factors that may undermine the incentives of such
contractors to optimize treatment outcomes in managing the
care of covered beneficiaries without exceeding budgeted
resources.
(4) The cost impacts, if any, of the use of commercial
managed care methods of furnishing pharmaceuticals to covered
beneficiaries by TRICARE program contractors instead of
H. R. 1119—194
procuring pharmaceuticals at discounted prices pursuant to
section 8126 of title 38, United States Code.
(5) The existence of options for increasing the discounts
available to TRICARE program contractors without undermin-
ing controls for preventing diversion of items procured by the
Department of Defense to nonmilitary populations.
(b) RESPONSE TO STUDY.—Not later than 90 days after the
Comptroller General submits to Congress the study required by
subsection (a), the Secretary of Defense shall submit to Congress
a report on the feasibility and advisability of implementing changes
to the pharmacy programs of the Department of Defense based
on the findings and conclusions of the study.
SEC. 748. COMPTROLLER GENERAL STUDY OF NAVY GRADUATE MEDI-
CAL EDUCATION PROGRAM.
(a) STUDY REQUIRED.—The Comptroller General shall conduct
a study to evaluate the validity of the recommendations made
by the Medical Education Policy Council of the Bureau of Medicine
and Surgery of the Navy regarding restructuring the graduate
medical education program of the Department of the Navy. The
study shall specifically address the Council’s recommendations
relating to residency training conducted at the Naval Medical Cen-
ter, Portsmouth, Virginia, and the National Naval Medical Center,
Bethesda, Maryland.
(b) SUBMISSION OF REPORT.—Not later than March 1, 1998,
the Comptroller General shall submit to Congress and the Secretary
of the Navy a report containing the results of the study required
by subsection (a).
(c) MORATORIUM ON RESTRUCTURING.—Until the report required
by subsection (b) is submitted to Congress, the Secretary of the
Navy may not make any change in the types of residency programs
conducted under the Navy graduate medical education program
or the locations at which such residency programs are conducted
or otherwise restructure the Navy graduate medical education pro-
gram.
SEC. 749. STUDY OF EXPANSION OF PHARMACEUTICALS BY MAIL PRO-
GRAM TO INCLUDE ADDITIONAL MEDICARE-ELIGIBLE
COVERED BENEFICIARIES.
Not later than six months after the date of the enactment
of this Act, the Secretary of Defense shall submit to Congress
a report regarding the feasibility and advisability of expanding
the category of persons eligible to participate in the demonstration
project for the purchase of prescription pharmaceuticals by mail,
as required by section 702(a) of the National Defense Authorization
Act for Fiscal Year 1993 (Public Law 102–484; 10 U.S.C. 1079
note), to include persons referred to in subsection (c) of section
1086 of title 10, United States Code, who are covered by subsection
(d)(1) of such section and reside in the United States outside of
the catchment area of a medical treatment facility of the uniformed
services.
SEC. 750. COMPTROLLER GENERAL STUDY OF REQUIREMENT FOR
MILITARY MEDICAL FACILITIES IN NATIONAL CAPITAL
REGION.
(a) STUDY REQUIRED.—The Comptroller General shall conduct
a study to evaluate the requirements for Army, Navy, and Air
Force medical facilities in the National Capital Region (as defined
H. R. 1119—195
in section 2674(f)(2) of title 10, United States Code). The study
shall—
(1) specifically address requirements with respect to geog-
raphy, facilities, integrated residencies, and medical environ-
ments; and
(2) provide specific recommendations with respect to how
medical and health care provided by these facilities may be
better coordinated to more efficiently serve, throughout the
National Capital Region, members of the Armed Forces on
active duty and covered beneficiaries under chapter 55 of title
10, United States Code.
(b) SUBMISSION OF REPORT.—Not later than six months after
the date of the enactment of this Act, the Comptroller General
shall submit to Congress and the Secretary of Defense a report
containing the results of the study required by subsection (a).
SEC. 751. REPORT ON POLICIES AND PROGRAMS TO PROMOTE
HEALTHY LIFESTYLES FOR MEMBERS OF THE ARMED
FORCES AND THEIR DEPENDENTS.
(a) REPORT.—Not later than March 30, 1998, the Secretary
of Defense shall submit to the Committee on Armed Services of
the Senate and the Committee on National Security of the House
of Representatives a report on the effectiveness of the policies
and programs of the Department of Defense intended to promote
healthy lifestyles for members of the Armed Forces and their
dependents.
(b) POLICIES
AND PROGRAMS TO BE ASSESSED.—The report
under subsection (a) shall include an assessment of the effectiveness
of the following:
(1) Programs intended to educate members of the Armed
Forces and their dependents about the potential health con-
sequences of the use of alcohol and tobacco.
(2) Policies of the commissaries, post exchanges, and service
clubs, and for entertainment activities of the Department of
Defense, relating to the sale and use of alcohol and tobacco.
(3) Programs intended to provide support to members of
the Armed Forces and their dependents who choose to reduce
or eliminate their use of alcohol or tobacco.
(4) Any other policies or programs intended to promote
healthy lifestyles for members of the Armed Forces and their
dependents.
SEC. 752. SENSE OF CONGRESS REGARDING QUALITY HEALTH CARE
FOR RETIREES.
(a) FINDINGS.—Congress makes the following findings:
(1) Many retired military personnel believe that they were
promised lifetime health care in exchange for 20 or more years
of service.
(2) Military retirees are the only Federal Government
personnel who have been prevented from using their employer-
provided health care at or after 65 years of age.
(3) Military health care has become increasingly difficult
to obtain for military retirees as the Department of Defense
reduces its health care infrastructure.
(4) Military retirees deserve to have a health care program
that is at least comparable with that of retirees from civilian
employment by the Federal Government.