I
106TH CONGRESS
2D SESSION
H. R. 3655
To make certain improvements to the military health care system.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY 15, 2000
Mr. ABERCROMBIE (for himself, Mr. SKELTON, Mr. TAYLOR of Mississippi,
Mr. LARSON, Mr. REYES, Mr. THOMPSON of California, Mrs. TAUSCHER,
Mr. MALONEY of Connecticut, Ms. MCKINNEY, Mr. TURNER, Mr. KEN-
NEDY of Rhode Island, Mr. ORTIZ, Ms. SANCHEZ, Mr. RODRIGUEZ, Mr.
SMITH of Washington, Mr. UNDERWOOD, and Mr. SISISKY) introduced
the following bill; which was referred to the Committee on Ways and
Means, and in addition to the Committees on Armed Services, Commerce,
and Government Reform, for a period to be subsequently determined by
the Speaker, in each case for consideration of such provisions as fall with-
in the jurisdiction of the committee concerned
A BILL
To make certain improvements to the military health care
system.
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 ‘‘Improved Medical Care
for Troops and Retirees Act’’.
SEC. 2. MEDICARE SUBVENTION PROJECT FOR MILITARY
RETIREES AND DEPENDENTS.
(a) FUTURE REPEAL OF LIMITATION ON NUMBER OF
SITES.—Effective January 1, 2001, paragraph (2) of sec-
tion 1896(b) of section 1896 of the Social Security Act
(42 U.S.C. 1395ggg) is amended to read as follows:
‘‘(2) LOCATION OF SITES.—The program shall be
conducted in any site designated jointly by the admin-
istering Secretaries, and shall be conducted nationwide by
January 1, 2006.’’.
(b) MAKING PROJECT PERMANENT; CHANGES
IN
PROJECT REFERENCES.—
(1) ELIMINATION OF TIME LIMITATION.—Para-
graph (4) of section 1896(b) of such Act is repealed.
(2) TREATMENT OF CAPS.—Subsection (i)(4) of
section 1896 of such Act is amended by adding at
the end the following:
‘‘This paragraph shall not apply after calendar
year 2001.’’.
(3) CONFORMING CHANGES OF REFERENCES TO
DEMONSTRATION PROJECT.—Section 1896 of such
Act is further amended—
(A) in the heading, by striking ‘‘DEM-
ONSTRATION
PROJECT’’ and inserting ‘‘PRO-
GRAM’’;
(B) by amending subsection (a)(2) to read
as follows:
‘‘(2) PROGRAM.—The term ‘program’ means the pro-
gram carried out under this section.’’;
(C) in the heading to subsection (b), by
striking ‘‘DEMONSTRATION PROJECT’’ and in-
serting ‘‘PROGRAM’’;
(D) by striking ‘‘demonstration project’’ or
‘‘project’’ each place either appears and insert-
ing ‘‘program’’;
(E) in subsection (k)(2)—
(i) by striking ‘‘EXTENSION AND EX-
PANSION
OF
DEMONSTRATION
PROJECT’’
and inserting ‘‘PROGRAM’’; and
(ii) by striking subparagraphs (A)
through (C) and inserting the following:
‘‘(A) whether there is a cost to the health
care program under this title in conducting the
program under this section; and
‘‘(B) whether the terms and conditions of
the program should be modified.’’.
(4) REPORTS.—Subsection (k)(1) of section
1896 is amended in the second sentence—
(A) 
by 
striking 
‘‘the 
demonstration
project’’ and inserting ‘‘the program’’;
(B) by striking ‘‘, and the’’ and all that
follows through ‘‘date’’;
(C) by redesignating subparagraph (O) as
subparagraph (P); and
(D) by inserting after subparagraph (N)
the following new subparagraph:
‘‘(O) Patient satisfaction with the pro-
gram.’’.
(5) ADDITIONAL CONFORMING AMENDMENTS.—
Section 1896(b) of such Act is further amended—
(A) by redesignating paragraph (5) as
paragraph (4); and
(B) by striking ‘‘At least 60 days’’ and all
that follows through ‘‘agreement’’ and inserting
‘‘The administering Secretaries shall submit on
an annual basis the most current agreement’’.
(6) CONTINUATION OF PROVISION OF CARE.—
Section 1896(b) of such Act is further amended by
adding at the end the following new paragraph:
‘‘(6) CONTINUATION OF PROVISION OF CARE.—
With respect to any individual who receives health
care benefits under this section before the date of
the enactment of this paragraph, the administering
Secretaries shall not terminate such benefits unless
the individual ceases to fall within the definition of
the term ‘medicare-eligible military retiree or de-
pendent’ (as defined in subsection (a)).’’.
(c) PAYMENTS.—
(1) PERMITTING
PAYMENTS
ON
A
FEE-FOR-
SERVICE BASIS.—Section 1896 of the Social Security
Act is further amended by adding at the end the fol-
lowing new subsection:
‘‘(l) PAYMENT ON A FEE-FOR-SERVICE BASIS.—In-
stead of the payment method described in subsection (i)(1)
and in the case of individuals who are not enrolled in the
program in the manner described in subsection (d)(1), the
Secretary may reimburse the Secretary of Defense for
services provided under the program at a rate that does
not exceed the rate of payment that would otherwise be
made under this title for such services if sections 1814(c)
and 1835(d), and paragraphs (2) and (3) of section
1862(a), did not apply.’’.
(2) PAYMENTS TO MILITARY TREATMENT FA-
CILITIES.—Such section is further amended by add-
ing at the end the following new subsection:
‘‘(m) PAYMENTS TO MILITARY TREATMENT FACILI-
TIES.—The Secretary of Defense shall reimburse military
treatment facilities for the provision of health care under
this section.’’.
(3) CONFORMING AMENDMENTS.—Such section
is further amended—
(A) 
in 
subsections 
(b)(1)(B)(v) 
and
(b)(1)(B)(viii)(I), by inserting ‘‘or subsection
(l)’’ after ‘‘subsection (i)’’;
(B) in subsection (b)(2), by adding at the
end the following: ‘‘If feasible, at least one of
the sites shall be conducted using the fee-for-
service reimbursement method described in sub-
section (l).’’;
(C) in subsection (d)(1)(A), by inserting
‘‘(insofar as it provides for the enrollment of in-
dividuals and payment on the basis described in
subsection (i))’’ before ‘‘shall meet’’;
(D) in subsection (d)(1)(A), by inserting
‘‘and the program (insofar as it provides for
payment for facility services on the basis de-
scribed in subsection (l)) shall meet all require-
ments for such facilities under this title’’ after
‘‘medicare payments’’;
(E) in subsection (d)(2), by inserting ‘‘, in-
sofar as it provides for the enrollment of indi-
viduals and payment on the basis described in
subsection (i),’’ before ‘‘shall comply’’;
(F) in subsection (g)(1), by inserting ‘‘, in-
sofar as it provides for the enrollment of indi-
viduals and payment on the basis described in
subsection (i),’’ before ‘‘the Secretary of De-
fense’’;
(G) in subsection (i)(1), by inserting ‘‘and
subsection (l)’’ after ‘‘of this subsection’’;
(H) in subsection (i)(4), by inserting ‘‘and
subsection (l)’’ after ‘‘under this subsection’’;
and
(I) in subsection (j)(2)(B)(ii), by inserting
‘‘or subsection (l)’’ after ‘‘subsection (i)(1)’’.
(3) EFFECTIVE DATE.—The amendments made
by this subsection take effect on January 1, 2001,
and apply to services furnished on or after such
date.
(d) ELIMINATION
OF
RESTRICTION
ON
ELIGI-
BILITY.—Section 1896(b)(1) of such Act is amended by
adding at the end the following new subparagraph:
‘‘(C) ELIMINATION OF RESTRICTIVE POL-
ICY.—If the enrollment capacity in the program
has been reached at a particular site designated
under paragraph (2) and the Secretary there-
fore limits enrollment at the site to medicare-
eligible military retirees and dependents who
are enrolled in TRICARE Prime (as defined for
purposes of chapter 55 of title 10, United
States Code) at the site immediately before at-
taining 65 years of age, participation in the
program by a retiree or dependent at such site
shall not be restricted based on whether the re-
tiree or dependent has a civilian primary care
manager instead of a military primary care
manager.’’.
(e) MEDIGAP PROTECTION FOR ENROLLEES.—Sec-
tion 1896 of such Act is further amended by adding at
the end the following new subsection:
‘‘(m) MEDIGAP PROTECTION FOR ENROLLEES.—(1)
Subject to paragraph (2), the provisions of section
1882(s)(3) (other than clauses (i) through (iv) of subpara-
graph (B)) and 1882(s)(4) of the Social Security Act shall
apply to any enrollment (and termination of enrollment)
in the program (for which payment is made on the basis
described in subsection (i)) in the same manner as they
apply to enrollment (and termination of enrollment) with
a Medicare+Choice organization in a Medicare+Choice
plan.
‘‘(2) In applying paragraph (1)—
‘‘(A) in the case of enrollments occurring before
January 1, 2001, any reference in clause (v) or (vi)
of section 1882(s)(3)(B) of such Act to 12 months
is deemed a reference to the period ending on De-
cember 31, 2001; and
‘‘(B) the notification required under section
1882(s)(3)(D) of such Act shall be provided in a
manner specified by the Secretary of Defense in con-
sultation with the Director of the Office of Per-
sonnel Management.’’.
(f) REIMBURSEMENT RATES.—Section 1896 of such
Act is further amended in subsection (i)(1) by striking ‘‘95
percent of’’.
SEC. 3. EXTENSION OF FEHBP DEMONSTRATION PROGRAM.
Section 1108 of title 10, United States Code, is
amended—
(1) in subsection (b), by adding at the end the
following new paragraph:
‘‘(6) With respect to any individual who enrolls in the
program under this section and does not elect to dis-
continue enrollment, the Secretary shall not terminate the
enrollment of such individual after the termination of the
demonstration project unless the individual ceases to meet
the requirements described in subsection (b)(1).’’;
(2) in subsection (d)—
(A) in paragraph (1), by striking ‘‘three’’
and inserting ‘‘four’’; and
(B) in paragraph (2), by striking ‘‘2002’’
and inserting ‘‘2003’’;
(3) in subsection (f)(1), by striking ‘‘three’’ and
inserting ‘‘four’’;
(4) in subsections (j)(1) and (k), by striking
‘‘2002’’ and inserting ‘‘2003’’; and
(5) in subsection (l)(2), by striking ‘‘36
months’’ and inserting ‘‘48 months’’.
SEC. 4. COVERAGE OF FAMILY MEMBERS UNDER SUPPLE-
MENTAL CARE PROGRAM FOR MEMBERS AS-
SIGNED TO CERTAIN DUTY LOCATIONS FAR
FROM SOURCES OF CARE.
Section 731(b) of the National Defense Authorization
Act for Fiscal Year 1998 (Public Law 105–85; 10 U.S.C.
1074 note) is amended by adding at the end the following
new paragraph:
‘‘(4) A family member of a member described
in subsection (c) shall also be eligible to receive the
care described in subsection (a). For purposes of
this subsection, the term ‘family member’ shall have
the same meaning as the term ‘dependent’, as de-
fined for purposes of title 10, United States Code.’’.
SEC. 5. EXPANSION OF PHARMACY PROGRAM.
Section 723 of the Strom Thurmond National De-
fense Authorization Act for Fiscal Year 1999 (Public Law
105–261; 10 U.S.C. 1073 note) is amended—
(1) in subsection (a), by striking ‘‘who reside in
an area selected under subsection (f)’’;
(2) by amending subsection (f) to read as fol-
lows:
‘‘(f) BENEFITS TO BE OFFERED.—The pharmacy
benefits provided under the redesigned system imple-
mented under this section shall be at least equivalent to
the pharmacy benefits provided under section 702 of the
National Defense Authorization Act for Fiscal Year 1993
(Public Law 102–484; 10 U.S.C. 1079 note).’’; and
(3) by adding at the end the following new sub-
section:
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There
are authorized to be appropriated to carry out this
section—
‘‘(1) $455,000,000 for fiscal year 2001; and
‘‘(2) $485,000,000 for fiscal year 2002.’’.
SEC. 6. IMPROVEMENTS UNDER THE TRICARE PROGRAM.
(a) 
ELIMINATION
OF
COPAYMENTS
UNDER
TRICARE PRIME.—(1) Chapter 55 of title 10, United
States Code, is amended in section 1095d by adding at
the end the following new subsection:
‘‘(c) TERMINATION OF COPAYMENTS FOR CERTAIN
COVERED BENEFICIARIES.—The Secretary may not re-
quire a member of the uniformed services on active duty,
or the dependent of such a member, to pay a copayment
for health care services received under TRICARE
Prime.’’.
(2) The heading of such section is amended to read
as follows:
‘‘§ 1095d. TRICARE program: waiver of certain
deductibles and copayments’’.
(3) The item relating to section 1095d in the table
of sections at the beginning of such chapter 55 is amended
to read as follows:
‘‘1095d. TRICARE program: waiver of certain deductibles and copayments.’’.
(b) ELIMINATION
OF NON-AVAILABILITY STATE-
MENT REQUIREMENT; REDUCTION
OF CATASTROPHIC
CAP.—Chapter 55 of title 10, United States Code, is
amended by inserting after section 1095e the following
new section:
‘‘§ 1095f. TRICARE Program: non-availability state-
ment; catastrophic cap
‘‘(a) PROHIBITION ON REQUIREMENT TO OBTAIN
NON-AVAILABILITY STATEMENT.—The Secretary shall
not require a covered beneficiary to obtain a non-avail-
ability statement in order to receive health care services
under TRICARE Standard.
‘‘(b) REDUCTION OF CATASTROPHIC CAP.—The Sec-
retary shall reduce the catastrostrophic cap for covered
beneficiaries under TRICARE Standard and TRICARE
Extra to $3,000.’’.
(2) The table of sections at the beginning of such
chapter is amended by inserting after the item relating
to section 1095e the following new item:
‘‘1095f. TRICARE Program: Non-Availability Statement; Catastrophic Cap.’’.
SEC. 7. REIMBURSEMENT FOR CERTAIN TRAVEL EX-
PENSES.
(a) IN GENERAL.—Chapter 55 of title 10, United
States Code, is amended by inserting after section 1074g
the following new section:
‘‘§ 1074h. Reimbursement for certain travel expenses
‘‘In any case in which a covered beneficiary is re-
ferred by a primary care physician to a specialty care pro-
vider who provides services more than 100 miles from the
location in which the primary care provider provides serv-
ices to the member, the Secretary shall provide reimburse-
ment for reasonable travel expenses for the covered bene-
ficiary.’’.
(b) CLERICAL AMENDMENT.—The table of sections
at the beginning of such chapter is amended by adding
at the end the following new item:
‘‘1074h. Reimbursement for certain travel expenses.’’.
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