Stop Copay Overpay Act

Bill: 118-s-4891
Sponsor: full_name: Sen. Casey, Robert P., Jr. [D-PA]
Introduced: 2024-07-31
Policy area: Armed Forces and National Security
Latest action: action_date: 2024-07-31
text: Read twice and referred to the Committee on Armed Services.

Summaries:
action_date: 2024-07-31
action_desc: Introduced in Senate
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 beginning after this bill is enacted, DOD may not increase the co-payment amount charged to a covered individual above the amount that would have been charged in FY2021&nbsp;for any service (1) furnished by a specialty care provider under the TRICARE program, and (2) that is not an outpatient visit for&nbsp;mental or behavioral health care.&nbsp;</p>

tv_txt: II 118th CONGRESS 2d Session S. 4891 IN THE SENATE OF THE UNITED STATES July 31, 2024 Mr. Casey (for himself, Mr. Brown , Mrs. Gillibrand , Ms. Stabenow , Mr. Welch , and Ms. Klobuchar ) introduced the following bill; which was read twice and 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 of 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 with respect to a covered individual 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 an 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 (1) In general Not later than one year after the date of the enactment of this Act, the Secretary of Defense shall submit to the Committee on Armed Services of the Senate and the Committee on Armed Services of the House of Representatives 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. (2) Elements The report required under paragraph (1) shall include— (A) any findings by the Secretary as to whether the limitation under section 1075b of title 10, United States Code (as added by subsection (a)), 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 (B) recommendations by the Secretary on how to avoid such an increase, as applicable. (d) Definitions In this section: (1) Covered individual The term covered individual has the meaning given that term in section 1075b of title 10, United States Code, as added by subsection (a). (2) TRICARE program The term TRICARE program has the meaning given that term in section 1072 of such title.