Stop Copay Overpay Act

Bill: 117-hr-4824
Sponsor: full_name: Rep. Houlahan, Chrissy [D-PA-6]
Introduced: 2021-07-29
Policy area: Armed Forces and National Security
Subjects: Congressional oversight

Health care costs and insurance

Home and outpatient care

Mental health

Military medicine

Military personnel and dependents
Latest action: action_date: 2021-07-29
text: Referred to the House Committee on Armed Services.

Summaries:
action_date: 2021-07-29
action_desc: Introduced in House
text: <p><strong>Stop Copay Overpay Act</strong></p> <p>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.</p> <p>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.</p>

tv_txt: I 117th CONGRESS 1st Session H. R. 4824 IN THE HOUSE OF REPRESENTATIVES July 29, 2021 Ms. Houlahan (for herself and Mr. Reschenthaler ) introduced the following bill; which was referred to the Committee on Armed Services A BILL 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.

1. Short title This Act may be cited as the Stop Copay Overpay Act . 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: 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.