I
106TH CONGRESS
2D SESSION
H. R. 4369
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 HOUSE OF REPRESENTATIVES
MAY 3, 2000
Mr. LUCAS of Kentucky introduced the following bill; which was referred to
the Committee on Armed Services, and in addition to the Committees on
Government Reform, Veterans’ Affairs, Ways and Means, and Commerce,
for a period to be subsequently determined by the Speaker, in each case
for consideration of such provisions as fall within the jurisdiction of the
committee concerned
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 De-
fense Health Program, and for other purposes.
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 ‘‘Veterans’ Health Care
Improvement and Prescription Drug Cost Relief Act of
2000’’.
TITLE I—SENIOR HEALTH CARE
SEC. 101. EXTENSION OF TRICARE SENIOR SUPPLEMENT
DEMONSTRATION PROGRAM.
Section 722(a)(2) of the Strom Thurmond National
Defense Authorization Act for Fiscal Year 1999 (Public
Law 105–261; 112 Stat. 2065; 10 U.S.C. 1073 note) is
amended by striking ‘‘December 31, 2002’’ and inserting
‘‘December 31, 2005’’.
SEC. 102. TRICARE SENIOR PRIME DEMONSTRATION PRO-
GRAM.
(a) EXTENSION OF DEMONSTRATION PROGRAM.—
Paragraph (4) of section 1896(b) of the Social Security
Act (42 U.S.C. 1395ggg(b)) is amended by striking ‘‘3-
year period beginning on January 1, 1998’’ and inserting
‘‘period beginning on January 1, 1998, and ending on De-
cember 31, 2005’’.
(b) ADDITION
OF MAJOR MEDICAL CENTERS.—
Paragraph (1)(A) of such section 1895(b) is amended by
striking ‘‘in a military treatment facility’’ and inserting
‘‘in a Department of Defense medical center considered
by the Secretary to be a major medical center, in any other
military treatment facility,’’.
(c) DESIGNATION
OF ADDITIONAL SITES.—Para-
graph (2) of such section 1896(b) is amended to read as
follows:
‘‘(2) DESIGNATION OF SITES.—
‘‘(A) IN
GENERAL.—The project estab-
lished under this section shall be conducted at
sites designated jointly by the administering
Secretaries after review of all TRICARE re-
gions.
‘‘(B) SPECIFIC SITES.—The sites for the
project shall include the 6 sites designated in
accordance with subparagraph (A) before the
date of the enactment of the National Defense
Authorization Act for Fiscal Year 2001 and the
major medical centers designated after such
date in accordance with that subparagraph.’’.
SEC. 103. COVERAGE OF RETIREES OVER AGE 64 BY FED-
ERAL EMPLOYEES HEALTH BENEFITS PRO-
GRAM.
(a) EXTENSION OF COVERAGE FOR RETIREES OVER
AGE 64.—(1) Section 1108 of title 10, United States
Code, is amended by adding at the end the following:
‘‘(m) EXTENSION
OF COVERAGE
FOR RETIREES
OVER AGE 64.—(1) Eligible beneficiaries referred to in
subsection (b)(1) who will be at least 65 years of age on
December 31, 2002, shall be permitted to enroll, or to ex-
tend a previous enrollment entered into under subsection
(d)(2), during a period of open enrollment for the year
2003 (conducted in the fall of 2002).
‘‘(2) Subject to paragraphs (2) and (3) of subsection
(f), the period of enrollment, or extension of enrollment,
of an eligible beneficiary under paragraph (1) shall be
three years unless the beneficiary disenrolls before the ter-
mination of the demonstration project.
‘‘(3) The agreement under subsection (a) shall pro-
vide for continuation of the demonstration project for a
total of five contract years under the Federal Employees
Health Benefits program for eligible beneficiaries referred
to in paragraph (1).’’.
(2) Subsection (d) of such section is amended—
(A) in paragraph (1), by striking ‘‘three con-
tract years’’ and inserting ‘‘six contract years’’; and
(B) in paragraph (2), by striking ‘‘December
31, 2002’’ in the second sentence and inserting ‘‘De-
cember 31, 2005’’.
(3) Subsection (f)(1) of such section is amended by
adding at the end the following: ‘‘A beneficiary may not
extend the enrollment unless eligible to do so under sub-
section (m)(1).’’.
(b) ADDITIONAL AREAS OF COVERAGE.—Subsection
(c) of such section is amended—
(1) by striking ‘‘, but not more than ten,’’; and
(2) by striking the third sentence and inserting
the following: ‘‘In establishing the areas, the Sec-
retary and Director shall include an area that in-
cludes the catchment area of one or more military
medical treatment facilities, an area that is not lo-
cated in the catchment area of a military medical
treatment facility, an area in which there is a Medi-
care Subvention Demonstration project area under
section 1896 of title XVIII of the Social Security
Act (42 U.S.C. 1395ggg), and one area for each
TRICARE region. Each area selected after the date
of the enactment of the National Defense Authoriza-
tion Act for Fiscal Year 2001 shall be an area that
is not located in the catchment area of a military
medical treatment facility.’’.
SEC. 104. IMPLEMENTATION OF REDESIGNED PHARMACY
SYSTEM.
(a) ENROLLMENT FEE
AND DEDUCTIBLES RE-
QUIRED.—Subsection (b) of section 723 of the Strom
Thurmond National Defense Authorization Act for Fiscal
Year 1999 (Public Law 105–261; 112 Stat. 2068; 10
U.S.C. 1073 note) is amended to read as follows:
‘‘(b) ENROLLMENT
FEES, DEDUCTIBLES, 
AND
OTHER CHARGES.—(1) The Secretary may require each
eligible individual described in subsection (e) who partici-
pates in the redesigned pharmacy system to pay an enroll-
ment fee. The Secretary shall ensure that any such enroll-
ment fee required after December 31, 2000, is lower than
the enrollment fee charged under this subsection on such
date.
‘‘(2) The Secretary may also impose one or more
cost-sharing requirements for each individual referred to
in paragraph (1) for benefits under the redesigned phar-
macy system as follows:
‘‘(A) An annual deductible requirement for each
such individual.
‘‘(B) Any premiums, copayments, or other
charges that the Secretary would otherwise collect
from individuals similar to such individual.’’.
(b) PERIODIC PAYMENT OF PREMIUMS.—Subsection
(b) of such section is further amended by adding at the
end the following:
‘‘(2) An individual may elect to pay a premium
charged under this subsection on a monthly or quarterly
basis.’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall take effect on January 1, 2001, and shall
apply with respect to participation in the redesigned phar-
macy system under section 723 of Public Law 105–261
for months beginning on or after that date.
TITLE II—TRICARE PROGRAM
SEC. 201. ADDITIONAL BENEFICIARIES UNDER TRICARE
PRIME REMOTE PROGRAM IN CONUS.
(a) COVERAGE OF OTHER UNIFORMED SERVICES.—
(1) Section 1074(c) of title 10, United States Code, is
amended—
(A) by striking ‘‘armed forces’’ each place it ap-
pears, except in paragraph (3)(A), and inserting
‘‘uniformed services’’;
(B) in paragraph (1), by inserting after ‘‘mili-
tary department’’ in the first sentence the following:
‘‘, the Department of Transportation (with respect
to the Coast Guard when it is not operating as a
service in the Navy), or the Department of Health
and Human Services (with respect to the National
Oceanic and Atmospheric Administration and the
Public Health Service)’’;
(C) in paragraph (2), by adding at the end the
following:
‘‘(C) The Secretary of Defense shall consult
with the other administering Secretaries in the ad-
ministration of this paragraph.’’; and
(D) in paragraph (3)(A), by striking ‘‘The Sec-
retary of Defense may not require a member of the
armed forces described in subparagraph (B)’’ and
(b) COVERAGE OF IMMEDIATE FAMILY.—(1) Section
1079 of title 10, United States Code, is amended by add-
ing at the end the following:
‘‘(p)(1) Subject to such exceptions as the Secretary
of Defense considers necessary, coverage for medical care
under this section for the dependents referred to in sub-
section (a) of a member of the uniformed services referred
to in section 1074(c)(3) of this title who are residing with
the member, and standards with respect to timely access
to such care, shall be comparable to coverage for medical
care and standards for timely access to such care under
the managed care option of the TRICARE program known
as TRICARE Prime.
‘‘(2) The Secretary of Defense shall enter into ar-
rangements with contractors under the TRICARE pro-
gram or with other appropriate contractors for the timely
and efficient processing of claims under this subsection.
‘‘(3) The Secretary of Defense shall consult with the
other administering Secretaries in the administration of
this subsection.’’.
(2) Section 731(b) of the National Defense Author-
ization Act for Fiscal Year 1998 (Public Law 105–85; 111
Stat. 1811; 10 U.S.C. 1074 note) is amended—
(A) in paragraph (1), by adding at the end the
following: ‘‘A dependent of the member, as described
in subparagraph (A), (D), or (I) of section 1072(2)
of title 10, United States Code, who is residing with
the member shall have the same entitlement to care
and to waiver of charges as the member.’’; and
(B) in paragraph (2), by inserting ‘‘or depend-
ent of the member, as the case may be,’’ after ‘‘(2)
A member’’.
(c) EFFECTIVE DATE.—(1) The amendments made
by subsection (a)(2), with respect to members of the uni-
formed services, and the amendments made by subsection
(b)(2), with respect to dependents of members, shall take
effect on the date of the enactment of this Act and shall
expire with respect to a member or the dependents of a
member, respectively, on the later of the following:
(A) The date that is one year after the date of
the enactment of this Act.
(B) The date on which the amendments sub-
section (a)(1) or (b)(1) apply with respect to the
coverage of medical care for and provision of such
care to the member or dependents, respectively.
(2) Section 731(b)(3) of Public Law 105–85 does not
apply to a member of the Coast Guard, the National Oce-
anic and Atmospheric Administration, or the Commis-
sioned Corps of the Public Health Service, or to a depend-
ent of a member of a uniformed service.
SEC. 202. ELIMINATION OF COPAYMENTS FOR IMMEDIATE
FAMILY.
(a) NO COPAYMENT FOR IMMEDIATE FAMILY.—Sec-
tion 1097a of title 10, United States Code, is amended—
(1) by redesignating subsection (e) as sub-
section (f); and
(2) by inserting after subsection (d) the fol-
lowing new subsection (e):
‘‘(e) NO COPAYMENT FOR IMMEDIATE FAMILY.—No
copayment shall be charged a member for care provided
under TRICARE Prime to a dependent of a member of
the uniformed services described in subparagraph (A),
(D), or (I) of section 1072 of this title.’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall take effect on October 1, 2000, and
shall apply with respect to care provided on or after that
date.
SEC. 203. IMPROVEMENT IN BUSINESS PRACTICES IN THE
ADMINISTRATION OF THE TRICARE PRO-
GRAM.
(a) REQUIREMENT.—Not later than October 1, 2001,
the Secretary of Defense shall take actions that the Sec-
retary considers appropriate to improve the business prac-
tices used in administering the access of eligible persons
to health care services through the TRICARE program
under chapter 55 of title 10, United States Code, includ-
ing the practices relating to the following:
(1) The availability and scheduling of appoint-
ments.
(2) The filing, processing, and payment of
claims.
(3) Public relations efforts that are focused on
outreach to eligible persons.
(4) The continuation of enrollments without ex-
piration.
(5) The portability of enrollments nationwide.
(b) CONSULTATION.—The Secretary of Defense shall
consult with the other administering Secretaries in the de-
velopment of the actions to be taken under subsection (a).
(c) REPORT.—Not later than March 15, 2001, the
Secretary of Defense shall submit to the Committees on
Armed Services of the Senate and House of Representa-
tives a report on the actions to be taken under subsection
(a).
(d) DEFINITIONS.—In this section the terms ‘‘admin-
istering Secretaries’’ and ‘‘TRICARE program’’ shall have
the meanings given such terms in section 1072 of title 10,
United States Code.
TITLE 
III—JOINT 
INITIATIVES
WITH DEPARTMENT OF VET-
ERANS AFFAIRS
SEC. 301. TRACKING PATIENT SAFETY IN MILITARY AND
VETERANS HEALTH CARE SYSTEMS.
(a) CENTRALIZED TRACKING PROCESS.—The Sec-
retary of Defense and the Secretary of Veterans Affairs
shall jointly prescribe a centralized process for the report-
ing, compiling, and analysis of errors in the provision of
health care under the Defense Health Program and the
Department of Veterans Affairs health care system that
endanger patients beyond the normal risks associated with
the care and treatment of the patients.
(b) SAFETY INDICATORS, ET CETERA.—The process
shall include such indicators, standards, and protocols as
the Secretary of Defense and the Secretary of Veterans
Affairs consider necessary for the establishment and ad-
ministration of an effective process.
SEC. 
302. 
PHARMACEUTICAL 
IDENTIFICATION 
TECH-
NOLOGY.
(a) BAR CODE IDENTIFICATION TECHNOLOGY.—The
Secretary of Defense and the Secretary of Veterans Af-
fairs shall jointly develop a system for the use of bar codes
for the identification of pharmaceuticals.
(b) USE
IN
NATIONAL
MAIL
ORDER
PHARMA-
CEUTICALS DEMONSTRATION PROJECT.—The Secretary
of Defense, in consultation with the Secretary of Veterans
Affairs, shall experiment with the use of bar code identi-
fication of pharmaceuticals in the administration of the
mail order pharmaceutical demonstration project being
carried out under section 702 of the National Defense Au-
thorization Act for Fiscal Year 1993 (Public Law 102–
484; 106 Stat. 2431; 10 U.S.C. 1079 note).
TITLE IV—OTHER MATTERS
SEC. 401. PERMANENT AUTHORITY FOR CERTAIN PHARMA-
CEUTICAL BENEFITS.
(a) AUTHORITY.—(1) Chapter 55 of title 10, United
States Code, is amended by adding at the end the fol-
lowing:
‘‘§ 1110. Pharmaceutical benefits
‘‘(a) PHARMACEUTICALS BY MAIL.—The Secretary of
Defense shall authorize eligible persons to obtain prescrip-
tion pharmaceuticals by mail in connection with medical
care furnished to such persons under this chapter.
‘‘(b) RETAIL PHARMACY NETWORK.—To the max-
imum extent practicable, the Secretary of Defense shall
include in each managed health care program under this
chapter, a program to supply prescription pharmaceuticals
to eligible persons through a managed care network of
community retail pharmacies in the area covered by the
managed health care program.
‘‘(c) ELIGIBLE PERSONS.—A person is eligible to ob-
tain pharmaceuticals under the program of pharma-
ceuticals by mail under subsection (a) or through a retail
pharmacy network included in a managed health care pro-
gram under subsection (b) as follows:
‘‘(1) A person who is eligible for medical care
under a contract for medical care entered into by the
Secretary of Defense under section 1079 or 1086 of
this title.
‘‘(2) A person who would be eligible for medical
care under a contract for medical care entered into
under section 1086 of this title except for the oper-
ation of subsection (d)(1) of such section.
‘‘(d) PHARMACEUTICALS OFFERED.—The Secretary
of Defense shall determine the pharmaceuticals that may
be obtained by eligible persons under subsection (a) or (b).
‘‘(e) FEES.—The Secretary of Defense shall prescribe
an appropriate fee, charge, or copayment to be paid by
persons for pharmaceuticals obtained under subsection (a)
or (b).
‘‘(f) CONSULTATION REQUIREMENT.—The Secretary
of Defense shall consult with the other administering Sec-
retaries in the administration of this section.’’.
(2) The table of sections at the beginning of such
chapter is amended by adding at the end the following:
‘‘1110. Pharmaceutical benefits.’’.
(b) REPEAL OF SUPERSEDED AUTHORITY.—Section
702 of the National Defense Authorization Act for Fiscal
Year 1993 (Public Law 102–484; 106 Stat. 2431; 10
U.S.C. 1079 note) is repealed.
(c) EFFECTIVE DATE.—This section and the amend-
ments made by this section shall take effect on January
1, 2001.
SEC. 402. PROVISION OF DOMICILIARY AND CUSTODIAL
CARE FOR CHAMPUS BENEFICIARIES.
(a) 
CONTINUATION
OF
CARE
FOR
CERTAIN
CHAMPUS BENEFICIARIES.—Section 703(a)(1) of the
National Defense Authorization Act for Fiscal Year 2000
(Public Law 106–65; 113 Stat. 682; 10 U.S.C. 1077 note)
is amended by inserting before the period at the end the
following: ‘‘or by the prohibition in section 1086(d)(1) of
such title’’.
(b) COST LIMITATION FOR INDIVIDUAL CASE MAN-
AGEMENT PROGRAM.—(1) Section 1079(a)(17) of title 10,
United States Code, is amended—
(A) by inserting ‘‘(A)’’ after ‘‘(17)’’; and
(B) by adding at the end the following:
‘‘(B) The total amount expended under sub-
paragraph (A) for a fiscal year may not exceed
$100,000,000.’’.
(2) Section 703 of the National Defense Authoriza-
tion Act for Fiscal Year 2000 is amended by adding at
the end the following:
‘‘(e) COST LIMITATION.—The total amount paid for
services for eligible beneficiaries under subsection (a) for
a fiscal year (together with the costs of administering the
authority under that subsection) shall be included in the
expenditures limited by section 1079(a)(17)(B) of title 10,
United States Code.’’.
(2) The amendments made by paragraphs (1) and (2)
shall apply to fiscal years after fiscal year 1999.
SEC. 403. STUDIES OF ACCRUAL FINANCING FOR HEALTH
CARE FOR MILITARY RETIREES.
(a) STUDIES REQUIRED.—The Secretary of Defense
shall carry out two studies to assess the feasibility and
desirability of financing the military health care program
for retirees of the uniformed services on an accrual basis.
(b) SOURCES OF STUDIES.—The Secretary shall pro-
vide for—
(1) one of the studies under subsection (a) to
be conducted by one or more Department of Defense
organizations designated by the Secretary; and
(2) the other study to be conducted by an orga-
nization that is independent of the Department of
Defense and has expertise in financial programs and
health care.
(c) REPORTS.—(1) The Secretary shall provide for
the submission of a final report on each study to the Sec-
retary within such time as the Secretary determines nec-
essary to satisfy the requirement in paragraph (2).
(2) The Secretary shall transmit the final reports on
the studies to Congress not later than February 8, 2001.
The Secretary may include in the transmittal any com-
ments on the reports or on the matters studied that the
Secretary considers appropriate.
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