I
106TH CONGRESS
2D SESSION
H. R. 4418
To make various improvements in the military health care system with respect
to the TRICARE program.
IN THE HOUSE OF REPRESENTATIVES
MAY 10, 2000
Mr. JONES of North Carolina (for himself, Mr. STENHOLM, and Mr. THUNE)
introduced the following bill; which was referred to the Committee on
Armed Services
A BILL
To make various improvements in the military health care
system with respect to the TRICARE program.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘TRICARE Enhance-
ment Act of 2000’’.
SEC. 2. IMPROVEMENT OF ACCESS TO HEALTH CARE
UNDER THE TRICARE PROGRAM.
(a) WAIVER OF NONAVAILABILITY STATEMENT OR
PREAUTHORIZATION.—In the case of a covered beneficiary
under chapter 55 of title 10, United States Code, who is
enrolled in TRICARE Standard, the Secretary of Defense
may not require with regard to authorized health care
services (other than mental health services) under any new
contract for the provision of health care services under
such chapter that the beneficiary—
(1) obtain a nonavailability statement or
preauthorization from a military medical treatment
facility in order to receive the services from a civilian
provider; or
(2) obtain a nonavailability statement for care
in specialized treatment facilities outside the 200-
mile radius of a military medical treatment facility.
(b) NOTICE.—The Secretary may require that the
covered beneficiary inform the primary care manager of
the beneficiary of any health care received from a civilian
provider or in a specialized treatment facility.
(c) EXCEPTIONS.—Subsection (a) shall not apply if—
(1) the Secretary demonstrates significant cost
avoidance for specific procedures at the affected
military medical treatment facilities;
(2) the Secretary determines that a specific
procedure must be maintained at the affected mili-
tary medical treatment facility to ensure the pro-
ficiency levels of the practitioners at the facility; or
(3) the lack of nonavailability statement data
would significantly interfere with TRICARE con-
tract administration.
SEC. 3. IMPROVEMENTS IN MONITORING ACCESS TO CARE.
(a) IN GENERAL.—The Secretary of Defense shall
direct—
(1) that the Composite Health Care System be
used in lieu of the Customer Satisfaction Survey to
measure performance of the Department of Defense
in scheduling appointments in military medical
treatment facilities for covered beneficiaries under
TRICARE Prime in compliance with appointment
access standards of the TRICARE program;
(2) that any necessary modifications be made to
the Composite Health Care System in order that ap-
propriate access standards are used and standard-
ized throughout the military health-care system; and
(3) that compliance with the appointment time-
liness standards under the TRICARE program in
military medical treatment facilities be reported at
the individual military medical treatment facility
level, the service level, the system wide level, and by
various beneficiary categories.
(b) REPORT REQUIRED.—Not later than December
31, 2000, the Secretary shall submit to Congress a report
on efforts to carry out this section.
SEC. 
4. 
EXPANDED 
ACCESS 
TO 
CERTIFIED 
MENTAL
HEALTH COUNSELORS.
(a) IN GENERAL.—Section 1079 of title 10, United
States Code, is amended—
(1) in subsection (a)—
(A) in paragraph (8)—
(i) by striking ‘‘or marital counselors
(other than certified marriage and family
therapists)’’ and inserting ‘‘marital coun-
selors (other than certified marriage and
family therapists, or certified mental
health counselors)’’; and
(ii) by inserting ‘‘and certified mental
health counselors’’ after ‘‘services of cer-
tified marriage and family health thera-
pists’’; and
(B) in paragraph (13), by inserting ‘‘cer-
tified mental health counselor,’’ after ‘‘psycholo-
gist,’’; and
(2) by adding at the end the following:
‘‘(p)(1) For purposes of providing substance abuse
treatment services to covered beneficiaries under the
TRICARE program, the Secretary shall recognize cer-
tified professional mental health counselors as qualified
mental health providers who are able to prescribe the ap-
propriate level and course of treatment for substance
abuse disorders.
‘‘(2) For purposes of providing mental health evalua-
tions of covered beneficiaries under the TRICARE pro-
gram, the Secretary shall recognize certified professional
mental health counselors as mental health professionals
qualified to conduct mental health evaluations.’’.
(b) APPLICATION OF AMENDMENTS.—The amend-
ments made by subsection (a) shall apply with respect to
services of a certified mental health counselor provided
under section 1079 or 1086 of title 10, United States
Code, on or after the date of the enactment of this Act.
SEC. 5. REIMBURSEMENT OF CERTAIN COSTS INCURRED
BY COVERED BENEFICIARIES REFERRED FOR
CARE OUTSIDE LOCAL CATCHMENT AREA.
The Secretary of Defense shall require that any new
contract for the provision of health care services under the
TRICARE program under chapter 55 of title 10, United
States Code, shall require that in any case in which a cov-
ered beneficiary under such chapter who is enrolled in
TRICARE Prime is referred by a network provider or
military medical treatment facility to a provider or mili-
tary medical treatment facility more than 100 miles out-
side the catchment area of a military medical treatment
facility because a local provider is not available, the bene-
ficiary shall be reimbursed by the network provider or
military medical treatment facility making the referral for
the cost of personal automobile mileage, to be paid under
standard reimbursement rates for Federal employees, or
for the cost of air travel in amounts not to exceed standard
contract fares for Federal employees.
SEC. 6. REMOVAL OF RESTRICTION REGARDING REIM-
BURSEMENT CAP.
Section 1097b(a) of title 10, United States Code, is
amended by adding at the end the following:
‘‘(3) In circumstances in which TRICARE Standard
is a secondary payer for health care provided to a covered
beneficiary, TRICARE Standard shall provide reimburse-
ment to the health care provider in the amount of the dif-
ference between the amount paid by the primary insurance
provider and the total amount of the charges for the
health care provided to the beneficiary, but in no case—
‘‘(A) may the total amount paid by TRICARE
Standard exceed 115 percent of CHAMPUS max-
imum allowable charges; or
‘‘(B) may the total amount paid by the primary
insurance provider and TRICARE Standard exceed
the total amount of the charges for the health care
provided.’’.
SEC. 7. IMPROVEMENTS WITH RESPECT TO PROVISION OF
DENTAL CARE.
(a) EXPANSION OF APPEALS PROCESS.—The Sec-
retary of Defense shall extend the appeals process for res-
olution of claims for participating dental care providers
under the TRICARE program to non-network providers
who provide dental care to covered beneficiaries under
chapter 55 of title 10, United States Code, under such
program.
(b) DISENROLLMENT PROCESS FOR TRICARE RE-
TIREE DENTAL PROGRAM.—(1) With respect to the provi-
sion of dental care to military retirees and their depend-
ents under chapter 55 of title 10, United States Code, the
Secretary of Defense—
(A) shall require that a contract with a provider
allow for a period of not less than 10 business days,
beginning on the date of the submission of an appli-
cation for enrollment, during which the enrollee may
disenroll;
(B) shall provide for limited circumstances
under which disenrollment shall be permitted during
the 24-month initial enrollment period, without jeop-
ardizing the fiscal integrity of the dental program.
(2) The circumstances described in paragraph (1)(B)
shall include—
(A) a case in which a military retiree who is
also a Federal employee is assigned to a location
overseas which prevents utilization of dental benefits
in the United States;
(B) a case in which a military retiree or de-
pendent provides medical documentation with regard
to a diagnosis of a serious or terminal illness which
precludes the retiree or dependent from obtaining
dental care;
(C) a case in which severe financial hardship
would result; and
(D) any other instances which the Secretary
considers appropriate.
(3) Initial requests for disenrollment under this sec-
tion shall be made to the contractor, and appeals of a deci-
sion by the contractor, or policies with respect to the provi-
sion of dental care to retirees and their dependents under
the TRICARE program shall, at the request of the bene-
ficiary, be referred by the contractor (including all rel-
evant information collected by the contractor) to the
TRICARE Management Activity.