H. R. 2401—145
by the Secretary of Defense or the administering Secretaries to
the extent that the Secretary of Defense or the administering Sec-
retaries determine that—
‘‘(1) the State or local law or regulation is inconsistent
with a specific provision of the contract or a regulation promul-
gated by the Secretary of Defense or the administering Secretar-
ies pursuant to this chapter; or
‘‘(2) the preemption of the State or local law or regulation
is necessary to implement or administer the provisions of the
contract or to achieve any other important Federal interest.
‘‘(b) EFFECT OF PREEMPTION.—In the case of the preemption
under subsection (a) of a State or local law or regulation regarding
financial solvency, the Secretary of Defense or the administering
Secretaries shall require an independent audit of the prime contrac-
tor of each contract that is entered into pursuant to this chapter
and covered by the preemption. The audit shall be performed by
the Defense Contract Audit Agency.
‘‘(c) STATE DEFINED.—In this section, the term ‘State’ includes
the District of Columbia, the Commonwealth of Puerto Rico, the
Commonwealth of the Northern Mariana Islands, and each Terri-
tory and possession of the United States.’’.
(b) APPLICATION
OF AMENDMENT.—Section 1103 of title 10,
United States Code, as amended by subsection (a), shall apply
with respect to any contract entered into under chapter 55 of
such title before, on, or after the date of the enactment of this
Act.
SEC. 716. SPECIALIZED TREATMENT FACILITY PROGRAM AUTHORITY
AND ISSUANCE OF NONAVAILABILITY OF HEALTH CARE
STATEMENTS.
(a) AUTHORITY.—(1) Section 1105 of title 10, United States
Code, is amended to read as follows:
‘‘§ 1105. Specialized treatment facility program
‘‘(a) PROGRAM AUTHORIZED.—The Secretary of Defense may con-
duct a specialized treatment facility program pursuant to regula-
tions prescribed by the Secretary of Defense. The Secretary shall
consult with the other administering Secretaries in prescribing
regulations for the program and in conducting the program.
‘‘(b) FACILITIES AUTHORIZED TO BE USED.—Under the special-
ized treatment facility program, the Secretary may designate health
care facilities of the uniformed services and civilian health care
facilities as specialized treatment facilities.
‘‘(c) WAIVER OF NONEMERGENCY HEALTH CARE RESTRICTION.—
Under the specialized treatment facility program, the Secretary
may waive, with regard to the provision of a particular service,
the 40-mile radius restriction set forth in section 1079(a)(7) of
this title if the Secretary determines that the use of a different
geographical area restriction will result in a more cost-effective
provision of the service.
‘‘(d) CIVILIAN FACILITY SERVICE AREA.—For purposes of the
specialized treatment facility program, the service area of a civilian
health care facility designated pursuant to subsection (b) shall
be comparable in size to the service areas of facilities of the uni-
formed services.
‘‘(e) ISSUANCE OF NONAVAILABILITY OF HEALTH CARE STATE-
MENTS.—A covered beneficiary who resides within the service area
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H. R. 2401—146
of a specialized treatment facility designated under the specialized
treatment 
facility 
program 
may 
be 
required 
to 
obtain 
a
nonavailability of health care statement in the case of a specialized
service offered by the facility in order for the covered beneficiary
to receive the service outside of the program.
‘‘(f) PAYMENT
OF COSTS RELATED
TO CARE
IN SPECIALIZED
TREATMENT FACILITIES.—(1) Subject to paragraph (2), in connection
with the treatment of a covered beneficiary under the specialized
treatment facility program, the Secretary may provide the following
benefits:
‘‘(A) Full or partial reimbursement of a member of the
uniformed services for the reasonable expenses incurred by
the member in transporting a covered beneficiary to or from
a health care facility of the uniformed services or a civilian
health care facility at which specialized health care services
are provided pursuant to this chapter.
‘‘(B) Full or partial reimbursement of a person (including
a member of the uniformed services) for the reasonable
expenses of transportation, temporary lodging, and meals (not
to exceed a per diem rate determined in accordance with
implementing regulations) incurred by such person in accom-
panying a covered beneficiary as a nonmedical attendant to
a health care facility referred to in subparagraph (A).
‘‘(C) In-kind transportation, lodging, or meals instead of
reimbursements under subparagraph (A) or (B) for transpor-
tation, lodging, or meals, respectively.
‘‘(2) The Secretary may make reimbursements for or provide
transportation, lodging, and meals under paragraph (1) in the case
of a covered beneficiary only if the total cost to the Department
of Defense of doing so and of providing the health care in such
case is less than the cost to the Department of providing the
health care to the covered beneficiary by other means authorized
under this chapter.
‘‘(g) COVERED BENEFICIARY DEFINED.—In this section, the term
‘covered beneficiary’ means a person covered under section 1079
or 1086 of this title.
‘‘(h) EXPIRATION OF PROGRAM.—The Secretary may not carry
out the specialized treatment facility program authorized by this
section after September 30, 1995.’’.
(2) The table of sections at the beginning of chapter 55 of
such title is amended by striking out the item relating to section
1105 and inserting in lieu thereof the following:
‘‘1105. Specialized treatment facility program.’’.
(b) 
CLARIFICATION
OF
DETERMINATION
TO
ISSUE
NONAVAILABILITY OF HEALTH CARE STATEMENTS.—(1) Section 1080
of title 10, United States Code, is amended—
(A) by inserting ‘‘(a) ELECTION.—’’ before ‘‘A dependent’’;
and
(B) by adding at the end the following new subsection:
‘‘(b) ISSUANCE OF NONAVAILABILITY OF HEALTH CARE STATE-
MENTS.—In determining whether to issue a nonavailability of health
care statement for a dependent described in subsection (a), the
commanding officer of a facility of the uniformed services may
consider the availability of health care services for the dependent
pursuant to any contract or agreement entered into under this
chapter for the provision of health care services.’’.
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H. R. 2401—147
(2) Section 1086(e) of such title is amended by adding at the
end the following new sentence: ‘‘In addition, section 1080(b) of
this title shall apply in making the determination whether to issue
a nonavailability of health care statement for a person covered
by this section.’’.
(c) CONFORMING AMENDMENT.—Section 1079(a)(7) of title 10,
United States Code, is amended by striking out ‘‘except
that—’’ and all that follows through the semicolon at the end
of subparagraph (B) and inserting in lieu thereof the following:
‘‘except that those services may be provided in any case in which
another insurance plan or program provides primary coverage for
those services;’’.
SEC. 717. DELAY OF TERMINATION AUTHORITY REGARDING STATUS
OF CERTAIN FACILITIES AS UNIFORMED SERVICES TREAT-
MENT FACILITIES.
(a) TERMINATION AUTHORITY.—Section 1252(e) of the Depart-
ment of Defense Authorization Act, 1984 (42 U.S.C. 248d(e)) is
amended by striking out ‘‘December 31, 1993’’ in the first sentence
and inserting in lieu thereof ‘‘December 31, 1996’’.
(b) EVALUATION OF DOD-USTF PARTICIPATION AGREEMENTS.—
(1) The Comptroller General of the United States and the Director
of the Congressional Budget Office shall jointly prepare a report
evaluating the participation agreements entered into between Uni-
formed Services Treatment Facilities and the Secretary of Defense
under the authority of section 718(c) of the National Defense
Authorization Act for Fiscal Year 1991 (Public Law 101–510; 104
Stat. 1587).
(2) The report required under this subsection shall include
an evaluation of the following:
(A) The cost-effectiveness of the agreements compared to
other components of the military health care delivery system,
including the Civilian Health and Medical Program of the Uni-
formed Services.
(B) The impact of the agreements, during the four-year
term of the agreements, on the budget and expenditures of
the Department of Defense for health care programs.
(C) The cost and other implications of terminating the
agreements before their expiration.
(D) The health care services available through the Uni-
formed Services Treatment Facilities under the agreements
compared to the health care services available through other
components of the military health care delivery system.
(E) The beneficiary cost-sharing requirements of the Uni-
formed Services Treatment Facilities under the agreements
compared to the beneficiary cost-sharing requirements of other
components of the military health care delivery system.
(3) The report required under this subsection shall be submitted
to Congress not later than six months after the date of the enact-
ment of this Act.
(4) For purposes of this subsection:
(A) The term ‘‘Uniformed Services Treatment Facilities’’
means those facilities described in section 911(a) of the Military
Construction Authorization Act, 1982 (42 U.S.C. 248c(a)).
(B) The term ‘‘Civilian Health and Medical Program of
the Uniformed Services’’ has the meaning given that term
in section 1072(4) of title 10, United States Code.
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H. R. 2401—148
SEC. 718. MANAGED-CARE DELIVERY AND REIMBURSEMENT MODEL
FOR THE UNIFORMED SERVICES TREATMENT FACILITIES.
(a) TIME
FOR OPERATION
OF MANAGED-CARE DELIVERY
AND
REIMBURSEMENT MODEL.—Subsection (c) of section 718 of the
National Defense Authorization Act for Fiscal Year 1991 (Public
Law 101–510; 104 Stat. 1587) is amended—
(1) by striking out the first sentence; and
(2) by inserting before the second sentence the following:
‘‘(1) TIME FOR OPERATION.—Not later than the date of the
enactment of this Act, the Secretary of Defense shall begin
operation of a managed-care delivery and reimbursement model
that will continue to utilize the Uniformed Services Treatment
Facilities in the military health services system.’’.
(b) COPAYMENTS, EVALUATION, AND DEFINITION.—Such sub-
section is further amended by adding at the end the following
new paragraphs:
‘‘(2) COPAYMENTS.—A Uniformed Services Treatment Facil-
ity for which there exists a managed-care plan developed as
part of the model required by this subsection may impose
reasonable charges for inpatient and outpatient care provided
to all categories of beneficiaries enrolled in the plan. The sched-
ule and application of such charges shall be in accordance
with the terms and conditions specified in the plan.
‘‘(3) EVALUATION OF PERFORMANCE UNDER THE MODEL.—
(A) The Secretary of Defense shall utilize a federally funded
research and development center to conduct an independent
evaluation of the performance of each Uniformed Services
Treatment Facility operating under a managed-care plan devel-
oped as part of the model required by this subsection. The
evaluation shall include an assessment of the efficiency of the
Uniformed Services Treatment Facility in providing health care
under the plan. The assessment shall be made in the same
manner as provided in section 712(a) of the National Defense
Authorization Act for Fiscal Year 1993 (10 U.S.C. 1073 note)
for expansion of the CHAMPUS reform initiative.
‘‘(B) Not later than December 31, 1995, the center conduct-
ing the evaluation and assessment shall submit to the Secretary
of Defense and to Congress a report on the results of the
evaluation and assessment. The report shall include such rec-
ommendations regarding the managed-care delivery and
reimbursement model under this subsection as the entity
considers to be appropriate.
‘‘(4) DEFINITION.—For purposes of this subsection, the term
‘Uniformed Services Treatment Facility’ means a facility
described in section 911(a) of the Military Construction
Authorization Act, 1982 (42 U.S.C. 248c(a)).’’.
SEC. 719. FLEXIBLE DEADLINE FOR CONTINUATION OF CHAMPUS
REFORM INITIATIVE IN HAWAII AND CALIFORNIA.
Section 713(b)(1) of the National Defense Authorization Act
for Fiscal Year 1993 (Public Law 102–484; 10 U.S.C. 1073 note)
is amended by striking out ‘‘not later than August 1, 1993.’’ and
inserting in lieu thereof ‘‘as soon as practicable after the date
of the enactment of the National Defense Authorization Act for
Fiscal Year 1994.’’.
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