H. R. 1530—193
(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.
SEC. 718. SENSE OF CONGRESS REGARDING ACCESS TO HEALTH CARE
UNDER TRICARE PROGRAM FOR COVERED BENEFICIARIES
WHO ARE MEDICARE ELIGIBLE.
(a) FINDINGS.—Congress finds the following:
(1) Medical care provided in facilities of the uniformed
services is generally less expensive to the Federal Government
than the same care provided at Government expense in the
private sector.
(2) Covered beneficiaries under the military health care
provisions of chapter 55, United States Code, who are eligible
for medicare under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) deserve health care options that empower
them to choose the health plan that best fits their needs.
(b) SENSE
OF CONGRESS.—In light of the findings specified
in subsection (a), it is the sense of Congress that—
(1) the Secretary of Defense should develop a program
to ensure that such covered beneficiaries who reside in a region
in which the TRICARE program has been implemented con-
tinue to have adequate access to health care services after
the implementation of the TRICARE program; and
(2) as a means of ensuring such access, the budget for
fiscal year 1997 submitted by the President under section 1105
of title 31, United States Code, should provide for reimburse-
ment by the Health Care Financing Administration to the
Department of Defense for health care services provided to
such covered beneficiaries in medical treatment facilities of
the Department of Defense.
Subtitle C—Uniformed Services Treatment
Facilities
SEC. 721. DELAY OF TERMINATION OF STATUS OF CERTAIN FACILI-
TIES AS UNIFORMED SERVICES TREATMENT FACILITIES.
Section 1252(e) of the Department of Defense Authorization
Act, 1984 (42 U.S.C. 248d(e)) is amended by striking out ‘‘December
31, 1996’’ in the first sentence and inserting in lieu thereof ‘‘Septem-
ber 30, 1997’’.
SEC. 722. LIMITATION ON EXPENDITURES TO SUPPORT UNIFORMED
SERVICES TREATMENT FACILITIES.
Subsection (f) of section 1252 of the Department of Defense
Authorization Act, 1984 (42 U.S.C. 248d), is amended to read as
follows:
‘‘(f) LIMITATION
ON
EXPENDITURES.—The total amount of
expenditures by the Secretary of Defense to carry out this section
and section 911 of the Military Construction Authorization Act,
1982 (42 U.S.C. 248c), for fiscal year 1996 may not exceed
$300,000,000, adjusted by the Secretary to reflect the inflation
factor used by the Department of Defense for such fiscal year.’’.
H. R. 1530—194
SEC. 723. APPLICATION OF CHAMPUS PAYMENT RULES IN CERTAIN
CASES.
Section 1074 of title 10, United States Code, is amended by
adding at the end the following new subsection:
‘‘(d)(1) The Secretary of Defense may require, by regulation,
a private CHAMPUS provider to apply the CHAMPUS payment
rules (subject to any modifications considered appropriate by the
Secretary) in imposing charges for health care that the private
CHAMPUS provider provides to a member of the uniformed services
who is enrolled in a health care plan of a facility deemed to
be a facility of the uniformed services under section 911(a) of
the Military Construction Authorization Act, 1982 (42 U.S.C.
248c(a)) when the health care is provided outside the catchment
area of the facility.
‘‘(2) In this subsection:
‘‘(A) The term ‘private CHAMPUS provider’ means a pri-
vate facility or health care provider that is a health care pro-
vider under the Civilian Health and Medical Program of the
Uniformed Services.
‘‘(B) The term ‘CHAMPUS payment rules’ means the pay-
ment rules referred to in subsection (c).
‘‘(3) The Secretary of Defense shall prescribe regulations under
this subsection after consultation with the other administering Sec-
retaries.’’.
SEC. 724. APPLICATION OF FEDERAL ACQUISITION REGULATION TO
PARTICIPATION AGREEMENTS WITH UNIFORMED SERV-
ICES TREATMENT FACILITIES.
(a) Section 718(c) of the National Defense Authorization Act
for Fiscal Year 1991 (Public Law 101–510; 104 Stat. 1587) is
amended—
(1) in the second sentence of paragraph (1), by striking
out ‘‘A participation agreement’’ and inserting in lieu thereof
‘‘Except as provided in paragraph (4), a participation
agreement’’;
(2) by redesignating paragraph (4) as paragraph (6); and
(3) by inserting after paragraph (3) the following new para-
graph:
‘‘(4) APPLICATION OF FEDERAL ACQUISITION REGULATION.—
On and after the date of the enactment of this paragraph,
Uniformed Services Treatment Facilities and any participation
agreement between Uniformed Services Treatment Facilities
and the Secretary of Defense shall be subject to the Federal
Acquisition Regulation issued pursuant to section 25(c) of the
Office of Federal Procurement Policy Act (41 U.S.C. 421(c))
notwithstanding any provision to the contrary in such a partici-
pation agreement. The requirements regarding competition in
the Federal Acquisition Regulation shall apply with regard
to the negotiation of any new participation agreement between
the Uniformed Services Treatment Facilities and the Secretary
of Defense under this subsection or any other provision of
law.’’.
(b) SENSE OF CONGRESS.—(1) Congress finds that the Uniformed
Services Treatment Facilities provide quality health care to the
120,000 Department of Defense beneficiaries enrolled in the Uni-
formed Services Family Health Plan provided by these facilities.
H. R. 1530—195
(2) In light of such finding, it is the sense of Congress that
the Uniformed Services Family Health Plan provided by the Uni-
formed Services Treatment Facilities should not be terminated for
convenience under provisions of the Federal Acquisition Regulation
by the Secretary of Defense before the expiration of the current
participation agreements.
(3) For purposes of this subsection, the term ‘‘Uniformed Serv-
ices Treatment Facility’’ means a facility deemed to be a facility
of the uniformed services by virtue of section 911(a) of the Military
Construction Authorization Act, 1982 (42 U.S.C. 248c(a)).
SEC. 725. DEVELOPMENT OF PLAN FOR INTEGRATING UNIFORMED
SERVICES TREATMENT FACILITIES IN MANAGED CARE
PROGRAMS OF DEPARTMENT OF DEFENSE.
Section 718(c) of the National Defense Authorization Act for
Fiscal Year 1991 (Public Law 101–510; 104 Stat. 1587) is amended
by inserting after paragraph (4), as added by section 722, the
following new paragraph:
‘‘(5) PLAN FOR INTEGRATING FACILITIES.—(A) The Secretary
of Defense shall develop a plan under which Uniformed Services
Treatment Facilities could be included, before the expiration
date of the participation agreements entered into under this
section, in the exclusive health care provider networks estab-
lished by the Secretary for the geographic regions in which
the facilities are located. The Secretary shall address in the
plan the feasibility of implementing the managed care plan
of the Uniformed Services Treatment Facilities, known as
Option II, on a mandatory basis for all USTF Medicare-eligible
beneficiaries and the potential cost savings to the Military
Health Care Program that could be achieved under such option.
‘‘(B) The Secretary shall submit the plan developed under
this paragraph to Congress not later than March 1, 1996.
‘‘(C) The plan developed under this paragraph shall be
consistent with the requirements specified in paragraph (4).
If the plan is not submitted to Congress by the expiration
date of the participation agreements entered into under this
section, the participation agreements shall remain in effect,
at the option of the Uniformed Services Treatment Facilities,
until the end of the 180-day period beginning on the date
the plan is finally submitted.
‘‘(D) For purposes of this paragraph, the term ‘USTF Medi-
care-eligible beneficiaries’ means covered beneficiaries under
chapter 55 of title 10, United States Code, who are enrolled
in a managed health plan offered by the Uniformed Services
Treatment Facilities and entitled to hospital insurance benefits
under part A of title XVIII of the Social Security Act (42
U.S.C. 1395c et seq.).’’.
SEC. 726. EQUITABLE IMPLEMENTATION OF UNIFORM COST SHARING
REQUIREMENTS FOR UNIFORMED SERVICES TREATMENT
FACILITIES.
(a) TIME FOR FEE IMPLEMENTATION.—The uniform managed
care benefit fee and copayment schedule developed by the Secretary
of Defense for use in all managed care initiatives of the military
health service system, including the managed care program of the
Uniformed Services Treatment Facilities, shall be extended to the
managed care program of a Uniformed Services Treatment Facility
only after the later of—
H. R. 1530—196
(1) the implementation of the TRICARE regional program
covering the service area of the Uniformed Services Treatment
Facility; or
(2) the end of the 180-day period beginning on the date
of the enactment of this Act.
(b) SUBMISSION OF ACTUARIAL ESTIMATES.—Paragraph (2) of
subsection (a) shall operate as a condition on the extension of
the uniform managed care benefit fee and copayment schedule
to the Uniformed Services Treatment Facilities only if the Uni-
formed Services Treatment Facilities submit to the Comptroller
General of the United States, within 30 days after the date of
the enactment of this Act, actuarial estimates in support of their
contention that the extension of such fees and copayments will
have an adverse effect on the operation of the Uniformed Services
Treatment Facilities and the enrollment of participants.
(c) EVALUATION.—(1) Except as provided in paragraph (2), not
later than 90 days after the date of the enactment of this Act,
the Comptroller General shall submit to Congress the results of
an evaluation of the effect on the Uniformed Services Treatment
Facilities of the extension of the uniform benefit fee and copayment
schedule to the Uniformed Services Treatment Facilities. The eval-
uation shall include an examination of whether the benefit fee
and copayment schedule may—
(A) cause adverse selection of enrollees;
(B) be inappropriate for a fully at-risk program similar
to civilian health maintenance organizations; or
(C) result in an enrolled population dissimilar to the gen-
eral beneficiary population.
(2) The Comptroller General shall not be required to prepare
or submit the evaluation under paragraph (1) if the Uniformed
Services Treatment Facilities fail to satisfactorily comply with sub-
section (b), as determined by the Comptroller General.
SEC. 727. ELIMINATION 
OF 
UNNECESSARY 
ANNUAL 
REPORTING
REQUIREMENT 
REGARDING 
UNIFORMED 
SERVICES
TREATMENT FACILITIES.
Section 1252 of the Department of Defense Authorization Act,
1984 (42 U.S.C. 248d), is amended by striking out subsection (d).
Subtitle D—Other Changes to Existing
Laws Regarding Health Care Management
SEC. 731. MAXIMUM ALLOWABLE PAYMENTS TO INDIVIDUAL HEALTH-
CARE PROVIDERS UNDER CHAMPUS.
(a) MAXIMUM PAYMENT.—Subsection (h) of section 1079 of title
10, United States Code, is amended by striking out paragraph
(1) and inserting in lieu thereof the following new paragraph:
‘‘(1) 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) may not exceed the lesser of—
‘‘(A) the amount equivalent to the 80th percentile of billed
charges made for similar services in the same locality during
the base period; or
‘‘(B) an amount determined to be appropriate, to the extent
practicable, in accordance with the same reimbursement rules