Stop Copay Overpay Act
Bill: H.R.4824 | Sponsor: Rep. Houlahan, Chrissy (D-PA)
Policy area: Armed Forces and National Security

Summary:
Stop Copay Overpay Act
This bill prohibits the Department of Defense (DOD) from charging a covered individual (i.e., individuals enrolled under the TRICARE program) a co-payment exceeding a certain rate for an outpatient visit for mental health or behavioral health under the TRICARE program, regardless of whether the visit is furnished by a specialty care provider. Specifically, the co-payment amount may not exceed the amount of a co-payment that would be charged under the TRICARE program for an outpatient visit for primary care services.
During the one-year period after this bill is enacted, DOD may not increase the co-payment amount charged to a covered individual for any service (1) furnished by a specialty care provider under the TRICARE program, and (2) that is not mental or behavioral health care.

To amend title 10, United States Code, to direct the Secretary of 
Defense to limit copayments for outpatient visits for mental health or 
  behavioral health under the TRICARE program, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Stop Copay Overpay Act''.

SEC. 2. LIMITATION ON COPAYMENTS FOR OUTPATIENT VISITS FOR MENTAL OR 
              BEHAVIORAL HEALTH UNDER TRICARE PROGRAM.

    (a) Limitation on Mental or Behavioral Health Copayments.--
            (1) Limitation.--Chapter 55 of title 10, United States 
        Code, is amended by inserting after the item relating to 
        section 1075a the following new section:
``Sec. 1075b. TRICARE program: limitation on copayments for certain 
              mental or behavioral health visits
    ``(a) Limitation on Copayments.--Notwithstanding any other 
provision under this chapter, the Secretary of Defense may not charge 
to a covered individual a copayment in an amount greater than the 
amount described in subsection (b) for an outpatient visit for mental 
health or behavioral health under the TRICARE program, regardless of 
whether such outpatient visit is furnished by a specialty care 
provider.
    ``(b) Amount Described.--The amount described in this subsection is 
the amount of a copayment that would be charged to the covered 
individual under the TRICARE Program for an outpatient visit for 
primary care services during the year in which the covered individual 
is being charged pursuant to subsection (a).
    ``(c) Covered Individual Defined.--In this section, the term 
`covered individual' means any individual enrolled under the TRICARE 
program, regardless of the beneficiary category of the individual with 
respect to such program or the duty status of the individual.''.
            (2) Clerical amendment.--The table of sections for such 
        chapter is amended by inserting after the item relating to 
        section 1075a the following new section:

``1075b. TRICARE program: limitation on copayments for certain mental 
                            or behavioral health visits.''.
            (3) Applicability.--The amendments made by this subsection 
        shall apply with respect to outpatient visits for mental or 
        behavioral health occurring on or after the date of the 
        enactment of this Act.
    (b) Temporary Limitation on Other Specialty Care Copayments.--
            (1) Temporary limitation.--During the one-year period 
        beginning on the date of the enactment of this Act, the 
        Secretary of Defense may not increase the amount of a copayment 
        charged to a covered individual for any service described in 
        paragraph (2) beyond the amount that the Secretary would have 
        charged to the covered individual for such service during 
        fiscal year 2021.
            (2) Services described.--A service described in this 
        paragraph is a service--
                    (A) that is furnished to a covered individual by a 
                specialty care provider under the TRICARE program; and
                    (B) that is not covered under section 1075b of 
                title 10, United States Code, as added by subsection 
                (a).
            (3) Applicability.--The limitation on copayments specified 
        in paragraph (1) shall apply with respect to specialty care 
        received on or after the date of the enactment of this Act.
    (c) Report on Effects of Limitations.--Not later than one year 
after the date of the enactment of this Act, the Secretary shall submit 
to the Committees on Armed Services of the House of Representatives and 
the Senate a report on how the limitation under section 1075b of title 
10, United States Code (as added by subsection (a)) has affected, or 
may affect, the health care system of the Department of Defense. Such 
report shall include--
            (1) any findings by the Secretary as to whether the 
        limitation under such section 1075b may result in an increase 
        in copayments charged for services described in subsection 
        (b)(2) after the period specified in subsection (b)(1) 
        concludes; and
            (2) recommendations by the Secretary on how to avoid such 
        an increase, as applicable.
    (d) Definitions.--In this section:
            (1) The term ``covered individual'' has the meaning given 
        such term in section 1075b of title 10, United States Code, as 
        added by subsection (a).
            (2) The term ``TRICARE program'' has the meaning given such 
        term in section 1072 of such title.
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