I
106TH CONGRESS
1ST SESSION
H. R. 1067
To amend title 10, United States Code, to improve the access to military
treatment facilities for retired members of the uniformed services, and
their dependents, who are over 65 years of age, to provide for Medicare
reimbursement for health care services provided to such persons, and
to permit such persons to enroll in the Federal Employees Health Bene-
fits program.
IN THE HOUSE OF REPRESENTATIVES
MARCH 10, 1999
Mr. THORNBERRY introduced the following bill; which was referred to the
Committee on Ways and Means, and in addition to the Committees on
Commerce, Armed Services, and Government Reform, 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 con-
cerned
A BILL
To amend title 10, United States Code, to improve the
access to military treatment facilities for retired members
of the uniformed services, and their dependents, who
are over 65 years of age, to provide for Medicare reim-
bursement for health care services provided to such per-
sons, and to permit such persons to enroll in the Federal
Employees Health Benefits program.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
(5) SECRETARIES.—The term ‘‘Secretaries’’
means the Secretary of Defense and the Secretary of
Health and Human Services acting jointly.
SEC. 102. AVAILABILITY OF TRICARE-PRIME FOR MEDI-
CARE-ELIGIBLE UNIFORMED SERVICES RE-
TIREES.
The Secretary of Defense may not prohibit the enroll-
ment of Medicare-eligible uniformed services retirees in
the managed care option of the TRICARE program
(known as TRICARE prime) solely on account of age or
the entitlement of such persons to hospital insurance bene-
fits under part A of title XVIII of the Social Security Act
(42 U.S.C. 1395c et seq.).
SEC. 103. MEDICARE REIMBURSEMENT.
(a) REIMBURSEMENT REQUIRED.—To increase the
number of Medicare-eligible uniformed services retirees
able to enroll in the managed care option of the TRICARE
program, the Secretary of Defense and the Secretary of
Health and Human Services shall jointly establish a pro-
gram to provide the Department of Defense with reim-
bursement, beginning October 1, 2000, from the Medicare
program under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) for health care services provided to
Medicare-eligible uniformed services retirees through the
TRICARE program. Reimbursement will only be provided
in the case of Medicare-eligible uniformed services retirees
who are also enrolled in the supplementary medical insur-
ance program under part B of title XVIII of the Social
Security Act (42 U.S.C. 1395j et seq.).
(b) VOLUNTARY ENROLLMENT.—For purposes of the
subvention program, enrollment of Medicare-eligible uni-
formed services retirees in an option of the TRICARE pro-
gram shall be voluntary, except that the total number of
Medicare-eligible uniformed services retirees so enrolled
shall be subject to the capacity and funding limitations
specified in sections 104 and 105.
(c) EFFECT OF ENROLLMENT.—In the case of a
Medicare-eligible uniformed services retiree who enrolls in
an option of the TRICARE program, payments may not
be made under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) other than under the subvention pro-
gram for health care services provided through the
TRICARE program, except that the Secretaries may pro-
vide exceptions for emergencies or other situations as the
Secretaries consider appropriate.
(d) TRICARE PROGRAM ENROLLMENT FEE WAIV-
ER.—The Secretary of Defense shall waive the enrollment
fee applicable to any Medicare-eligible uniformed services
retiree enrolled in the managed care option of the
TRICARE program for whom reimbursement may be
made under section 104.
(e) MODIFICATION OF TRICARE CONTRACTS.—In
carrying out the subvention program, the Secretary of De-
fense may amend existing TRICARE program contracts
as may be necessary to incorporate provisions specifically
applicable to Medicare-eligible uniformed services retirees
who enroll in an option of the TRICARE program.
(f) COST SHARING.—The Secretary of Defense may
establish cost sharing requirements for Medicare-eligible
uniformed services retirees who enroll in an option of the
TRICARE program and for whom reimbursement may be
made under section 104.
SEC. 104. DETERMINATION OF REIMBURSEMENT AMOUNTS.
(a) REIMBURSEMENT
OF DEPARTMENT
OF DE-
FENSE.—Beginning October 1, 2000, monthly payments
to the Department of Defense under the subvention pro-
gram shall be made from the Medicare program under title
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.)
on the basis that payments are made under section
1876(a) of the Act (42 U.S.C. 1395mm(a)).
(b) AMOUNT
OF
PAYMENTS.—The Secretary of
Health and Human Services shall make payments to the
Department of Defense from the Federal Hospital Insur-
ance Trust Fund and the Federal Supplementary Medical
Insurance Trust Fund (allocated by the Secretary of
Health and Human Services between each trust fund
based on the relative weight that each trust fund contrib-
utes to the required payment) at a per capita rate equal
to 93 percent of the applicable adjusted average per capita
cost for each Medicare-eligible uniformed services retiree
enrolled in the TRICARE program in excess of the num-
ber of such uniformed services retirees calculated under
section 105 for the Department of Defense maintenance
of health care effort.
SEC. 105. MAINTENANCE OF DEFENSE HEALTH CARE EF-
FORT.
(a) MAINTENANCE
OF EFFORT REQUIRED.—The
Secretary of Defense shall maintain the Department of
Defense health care efforts for Medicare-eligible uni-
formed services retirees so as to avoid imposing on the
Medicare program those costs that the Department of De-
fense would be expected to incur to provide health care
services to Medicare-eligible uniformed services retirees in
the absence of the subvention program.
(b) ESTIMATE OF PRIOR EFFORT.—For the first fis-
cal year of the subvention program, the Secretaries shall
estimate the amount expended by the Department of De-
fense for fiscal year 2000 for providing health care items
and services (other than pharmaceuticals provided to out-
patients) to Medicare-eligible uniformed services retirees.
For subsequent fiscal years, the amount so estimated shall
be adjusted for inflation, for differences between estimated
and actual amounts expended, and for major changes in
the Department of Defense health care budget.
(c) TARGET FOR DEFENSE EFFORT.—On the basis
of the estimate made under subsection (b), the Secretaries
shall establish monthly targets of the number of Medicare-
eligible uniformed services retirees for whom reimburse-
ment will not be provided to the Department of Defense
under section 104.
(d) PROTECTION OF MEDICARE PROGRAM AGAINST
INCREASED COSTS.—
(1) PURPOSE.—The purpose of this subsection
is to protect the Medicare program against costs in-
curred under section 104 in connection with the pro-
vision of health care services to Medicare-eligible
uniformed services retirees that would not have been
incurred by the Medicare program in the absence of
the reimbursement requirement.
(2) REVIEW BY COMPTROLLER GENERAL.—Not
later than December 31 of each year, the Comptrol-
ler General shall determine and submit to the Sec-
retaries and Congress a report on the extent, if any,
to which the costs of the Secretary of Defense under
the TRICARE program and the costs of the Sec-
retary of Health and Human Services under the
Medicare program have increased as a result of the
subvention program.
(3) ACTIONS TO PREVENT INCREASED COSTS.—
If the Secretaries determine that the trust funds
under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) still incur excess costs as a re-
sult of the subvention program, the Secretaries shall
take such steps as may be necessary to offset those
excess costs (and prevent future excess costs), in-
cluding suspension or termination of the subvention
program, adjustment of the payment rate under sec-
tion 104(b), or an adjustment of the maintenance of
effort requirements of the Department of Defense
under this section.
SEC. 106. DEPARTMENT OF DEFENSE PAYMENT OF LATE
ENROLLMENT PENALTY UNDER MEDICARE.
(a) DEPARTMENT OF DEFENSE PAYMENT.—In the
case of any Medicare-eligible uniformed services retiree
who enrolls under part B of title XVIII of the Social Secu-
rity Act and who, because of the date of such enrollment,
is subject to the late enrollment penalty imposed pursuant
to section 1839(b) of the Social Security Act on the
monthly premium under part B of such title, the Secretary
of Defense shall reimburse the Medicare-eligible uniformed
services retiree for the cost of such penalty by—
(1) increasing the amount of a payment other-
wise made by the Department of Defense to the
Medicare-eligible uniformed services retiree, such as
retired or retainer pay; or
(2) making a special payment to the Medicare-
eligible uniformed services retiree to cover the cost
of such penalty.
(b) ELIGIBLE
MEDICARE-ELIGIBLE
UNIFORMED
SERVICES
RETIREE
DESCRIBED.—A Medicare-eligible
uniformed services retiree referred to in this section is a
Medicare-eligible uniformed services retiree—
(1) who is at least 65 years of age and was eli-
gible to enroll under part B of title XVIII of the So-
cial Security Act, and
(2) who at the time the individual first satisfied
paragraph (1) or (2) of section 1836 of the Social
Security Act, did not elect to enroll (or to be deemed
enrolled) under section 1837 of the Social Security
Act during the individual’s initial enrollment period.
SEC. 107. MEDIGAP SPECIAL OPEN ENROLLMENT PERIOD
FOR CERTAIN UNIFORMED SERVICES RETIR-
EES AND DEPENDENTS.
(a) MEDIGAP SPECIAL OPEN ENROLLMENT PE-
RIOD.—Notwithstanding any other provision of law, in the
case of a Medicare-eligible uniformed services retiree who
seeks to enroll in a Medicare supplemental policy (as de-
fined in section 1882(g) of the Social Security Act), the
issuer of the Medicare supplemental policy—
(1) may not deny or condition the issuance or
effectiveness of a Medicare supplemental policy; and
(2) may not discriminate in the pricing of the
policy on the basis of the individual’s health status,
medical condition (including both physical and men-
tal illnesses), claims experience, receipt of health
care, medical history, genetic information, evidence
of insurability (including conditions arising out of
acts of domestic violence), or disability.
(b) ELIGIBLE
MEDICARE-ELIGIBLE
UNIFORMED
SERVICES
RETIREE
DESCRIBED.—A Medicare-eligible
uniformed services retiree referred to in this section is a
Medicare-eligible uniformed services retiree—
(1) who is at least 65 years of age and was eli-
gible to enroll under part B of title XVIII of the So-
cial Security Act, and
(2) who at the time the individual first satisfied
paragraph (1) or (2) of section 1836 of the Social
Security Act, did not elect to enroll (or to be deemed
enrolled) under section 1837 of the Social Security
Act during the individual’s initial enrollment period.
TITLE II—FEHBP OPTION FOR
RETIREES
SECTION. 201. INCLUSION OF MEDICARE-ELIGIBLE UNI-
FORMED SERVICES RETIREES IN FEDERAL
EMPLOYEES HEALTH BENEFITS PROGRAM.
(a) IN GENERAL.—Section 1108 of title 10, United
States Code, is amended to read as follows:
‘‘§ 1108. Health care coverage through Federal Em-
ployees Health Benefits program
‘‘(a) FEHBP OPTION.—The Secretary of Defense,
after consulting with the other administering Secretaries,
shall enter into an agreement with the Office of Personnel
Management under which eligible beneficiaries described
in subsection (b) may enroll in health benefits plans of-
fered through the Federal Employees Health Benefits pro-
gram under chapter 89 of title 5.
‘‘(b) ELIGIBLE BENEFICIARIES; COVERAGE.—(1) An
eligible beneficiary under this subsection is—
‘‘(A) a member or former member of the uni-
formed services described in section 1074(b) of this
title who is entitled to hospital insurance benefits
under part A of title XVIII of the Social Security
Act (42 U.S.C. 1395c et seq.);
‘‘(B) an individual who is an unremarried
former spouse of a member or former member de-
scribed in section 1072(2)(F) or 1072(2)(G));
‘‘(C) an individual who is—
‘‘(i) a dependent of a deceased member or
former member described in section 1076(b) or
1076(a)(2)(B) of this title or of a member who
died while on active duty for a period of more
than 30 days; and
‘‘(ii) a member of family as defined in sec-
tion 8901(5) of title 5; or
‘‘(D) an individual who is—
‘‘(i) a dependent of a living member or
former member described in section 1076(b)(1)
of this title who is entitled to hospital insurance
benefits under part A of title XVIII of the So-
cial Security Act, regardless of the member’s or
former member’s eligibility for such hospital in-
surance benefits; and
‘‘(ii) a member of family as defined in sec-
tion 8901(5) of title 5.
‘‘(2) Eligible beneficiaries may enroll in a Federal
Employees Health Benefit plan under chapter 89 of title
5 under this section for self-only coverage or for self and
family coverage which includes any dependent of the mem-
ber or former member who is a family member for pur-
poses of such chapter.
‘‘(3) A person eligible for coverage under this sub-
section shall not be required to satisfy any eligibility cri-
teria specified in chapter 89 of title 5 (except as provided
in paragraph (1)(C) or (1)(D)) as a condition for enroll-
ment in health benefits plans offered through the Federal
Employees Health Benefits program under this section.
‘‘(4) For purposes of determining whether an individ-
ual is a member of family under paragraph (5) of section
8901 of title 5 for purposes of paragraph (1)(C) or (1)(D),
a member or former member described in section 1076(b)
or 1076(a)(2)(B) of this title shall be deemed to be an
employee under such section.
‘‘(5) An eligible beneficiary who is eligible to enroll
in the Federal Employees Health Benefits program as an
employee under chapter 89 of title 5 is not eligible to en-
roll in a Federal Employees Health Benefits plan under
this section.
‘‘(c) PROHIBITION AGAINST USE OF MTFS AND EN-
ROLLMENT
UNDER
TRICARE.—Covered beneficiaries
under this chapter who are provided coverage under this
section shall not be eligible to receive care at a military
medical treatment facility or to enroll in a heath care plan
under the TRICARE program.
‘‘(d) SEPARATE RISK POOLS; CHARGES.—(1) The
Director of the Office of Personnel Management shall re-
quire health benefits plans under chapter 89 of title 5 that
participate under this section to maintain a separate risk
pool for purposes of establishing premium rates for eligible
beneficiaries who enroll in such a plan in accordance with
this section.
‘‘(2) The Director shall determine total subscription
charges for self only or for family coverage for eligible
beneficiaries who enroll in a health benefits plan under
chapter 89 of title 5 in accordance with this section. The
subscription charges shall include premium charges paid
to the plan and amounts described in section 8906(c) of
title 5 for administrative expenses and contingency re-
serves.
‘‘(e) GOVERNMENT CONTRIBUTIONS.—The Secretary
of Defense shall be responsible for the Government con-
tribution for an eligible beneficiary who enrolls in a health
benefits plan under chapter 89 of title 5 in accordance
with this section, except that the amount of the contribu-
tion may not exceed the amount of the Government con-
tribution which would be payable if the electing beneficiary
were an employee (as defined for purposes of such chap-
ter) enrolled in the same health benefits plan and level
of benefits.’’.
(b) CONFORMING AMENDMENTS.—(1) The item re-
lating to section 1108 in the table of sections at the begin-
ning of chapter 55 of title 10, United States Code, is
amended to read as follows:
‘‘1108. Health care coverage through Federal Employees Health Benefits pro-
gram.’’.
(2) Section 724 of the Strom Thurmond National De-
fense Authorization Act for Fiscal Year 1999 (Public Law
105–261; 112 Stat. 2069) is amended to read as follows:
‘‘SEC. 724. COMPREHENSIVE EVALUATION OF IMPLEMEN-
TATION OF DEMONSTRATION PROJECT AND
TRICARE PHARMACY REDESIGN.
‘‘Not later than March 31, 2003, the Comptroller
General shall submit to the Committees on Armed Serv-
ices of the Senate and the House of Representatives a re-
port containing a comprehensive comparative analysis of
the TRICARE Senior Supplement under section 722 and
the redesign of the TRICARE pharmacy system under
section 723. The comprehensive analysis shall incorporate
the findings of the evaluation submitted under section
723(c).’’.
(3) Chapter 89 of title 5, United States Code, is
amended—
(A) in section 8905(d), by striking ‘‘, as part of
the demonstration project under such section,’’;
(B) in section 8906(b)(4)—
(i) by striking ‘‘as part of the demonstra-
tion project’’; and
(ii) by striking ‘‘subsection (i)’’ and insert-
ing ‘‘subsection (e)’’;
(C) in section 8906(g)(3)—
(i) by striking ‘‘as part of the demonstra-
tion project’’; and
(ii) by striking ‘‘subsection (i)’’ and insert-
ing ‘‘subsection (e)’’; and
(D) in section 8909(g), by striking ‘‘the dem-
onstration project under’’.
SEC. 202. IMPROVED BENEFITS UNDER CHAMPUS AND
TRICARE STANDARD.
(a) COMPARABILITY.—(1) Chapter 55 of title 10,
United States Code, is further amended by inserting after
section 1108 the following new section:
‘‘§ 1109. CHAMPUS and TRICARE Standard benefits:
comparability with service benefit plan
of the Federal Employees Health Benefits
program
‘‘(a) BENEFITS.—The health and dental care benefits
provided under CHAMPUS and TRICARE Standard
shall be comparable to the highest level of benefits pro-
vided under the service benefit plan of the Federal Em-
ployees Health Benefits program.
‘‘(b) PROVIDER
REIMBURSEMENT
RATES.—The
rates prescribed for the reimbursement of health and den-
tal care providers under CHAMPUS and TRICARE
Standard shall be the same as those provided for the high-
est level of benefits under the service benefit plan of the
Federal Employees Health Benefits program.’’.
(2) The table of sections at the beginning of such
chapter is amended by inserting after the item relating
to section 1108 the following new item:
‘‘1109. CHAMPUS and TRICARE Standard benefits: comparability with serv-
ice benefit plan of the Federal Employees Health Benefits pro-
gram.’’.
(b) DEFINITIONS.—Section 1072 of title 10, United
States Code, is amended—
(1) in paragraph (4), by striking out ‘‘The term
‘Civilian Health and Medical Program of the Uni-
formed Services’ means’’ and inserting in lieu there-
of ‘‘The terms ‘Civilian Health and Medical Pro-
gram of the Uniformed Services’ and ‘CHAMPUS’
mean’’; and
(2) by adding at the end the following:
‘‘(8) The term ‘TRICARE Standard’ means a
CHAMPUS health care benefits option that, subject
to the deductibles and cost-sharing requirements
under CHAMPUS, pays a share of the cost of cov-
ered health care services that are provided by health
care providers outside the Federal Government who
are not part of the CHAMPUS network of health
care providers.
‘‘(9) The term ‘Federal Employee Health Bene-
fits program’ means the Federal Employee Health
Benefits program under chapter 89 of title 5.’’.
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