10 U.S.C. § 1073: Administration of this chapter

Except as otherwise provided in this chapter, the Secretary of Defense shall administer this chapter for the armed forces under his jurisdiction, the Secretary of Homeland Security shall administer this chapter for the Coast Guard when the Coast Guard is not operating as a service in the Navy, and the Secretary of Health and Human Services shall administer this chapter for the National Oceanic and Atmospheric Administration and the Public Health Service. This chapter shall be administered consistent with the Assisted Suicide Funding Restriction Act of 1997 ( 42 U.S.C. 14401 et seq.). Except as otherwise provided in this chapter, the Secretary of Defense shall have responsibility for administering the TRICARE program and making any decision affecting such program. The Secretary of Defense shall, to the maximum extent practicable, provide a stable program of benefits under this chapter throughout each fiscal year. To achieve the stability in the case of managed care support contracts entered into under this chapter, the contracts shall be administered so as to implement all changes in benefits and administration on a quarterly basis. However, the Secretary of Defense may implement any such change prior to the next fiscal quarter if the Secretary determines that the change would significantly improve the provision of care to eligible beneficiaries under this chapter. Not later than 180 days after the date of the enactment of this Act [ Dec. 27, 2021 ], the Secretary of Defense shall commence a pilot program, to be carried out for at least a one-year period, to provide direct assistance for mental health appointment scheduling under the direct care and purchased care components of the TRICARE program, through facilities and clinics selected by the Secretary for participation in the pilot program in a number determined by the Secretary. Not later than 180 days after the date of the enactment of this Act, the Secretary shall provide to the Committees on Armed Services of the House of Representatives and the Senate a briefing on the nature of the pilot program under subsection (a). the effectiveness of the pilot program with respect to improved access to mental health appointments; and any barriers to scheduling mental health appointments under the pilot program observed by health care professionals or other individuals involved in scheduling such appointments. In this section, the term ‘TRICARE program’ has the meaning given such term in section 1072 of title 10 , United States Code.” Not later than one year after the date of the enactment of this Act [ Jan. 1, 2021 ], the Secretary of Defense shall commence carrying out a demonstration project designed to evaluate the cost, quality of care, and impact on maternal and fetal outcomes of using extramedical maternal health providers under the TRICARE program to determine the appropriateness of making coverage of such providers under the TRICARE program permanent. Access to doulas. Access to lactation consultants or lactation counselors who are not otherwise authorized to provide services under the TRICARE program. The Secretary shall establish a process under which covered beneficiaries may enroll in the demonstration project to receive the services provided under the demonstration project. The Secretary shall carry out the demonstration project for a period of five years beginning on the date on which notification of the commencement of the demonstration project is published in the Federal Register. how many members of the Armed Forces or spouses of such members give birth while their spouse or birthing partner is unable to be present due to deployment, training, or other mission requirements; how many single members of the Armed Forces give birth alone; and how many members of the Armed Forces or spouses of such members use doula, lactation consultant, or lactation counselor support. The race, ethnicity, age, sex, relationship status, Armed Force, military occupation, and rank, as applicable, of each individual surveyed. If individuals surveyed were members of the Armed Forces or the spouses of such members, or both. The length of advanced notice received by individuals surveyed that the member of the Armed Forces would be unable to be present during the birth, if applicable. Any resources or support that the individuals surveyed found useful during the pregnancy and birth process, including doula, lactation consultant, or lactation counselor support. Not later than 180 days 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 plan to implement the demonstration project. Not later than one year after the date on which the demonstration project commences, and annually thereafter for the duration of the demonstration project, the Secretary shall submit to the Committees on Armed Services of the House of Representatives and the Senate a report on the cost of the demonstration project and the effectiveness of the demonstration project in improving quality of care and the maternal and fetal outcomes of covered beneficiaries enrolled in the demonstration project. The number of covered beneficiaries who are enrolled in the demonstration project. The number of enrolled covered beneficiaries who have participated in the demonstration project. The results of the surveys under subsection (e). The cost of the demonstration project. An assessment of the quality of care provided to participants in the demonstration project. An assessment of the impact of the demonstration project on maternal and fetal outcomes. An assessment of the effectiveness of the demonstration project. Recommendations for adjustments to the demonstration project. The estimated costs avoided as a result of improved maternal and fetal health outcomes due to the demonstration project. Recommendations for extending the demonstration project or implementing permanent coverage under the TRICARE program of extramedical maternal health providers. An identification of legislative or administrative action necessary to make the demonstration project permanent. The final report under subparagraph (A) shall be submitted not later than 90 days after the date on which the demonstration project terminates. If the Secretary determines that the demonstration project is successful, the Secretary may prescribe regulations to include extramedical maternal health providers as health care providers authorized to provide care under the TRICARE program. The Secretary may establish credentialing and other requirements for doulas, lactation consultants, and lactation counselors through public notice and comment rulemaking for purposes of including doulas, lactation consultants, and lactation counselors as health care providers authorized to provide care under the TRICARE program pursuant to regulations prescribed under paragraph (1). The terms ‘covered beneficiary’ and ‘TRICARE program’ have the meanings given those terms in section 1072 of title 10 , United States Code. The term ‘extramedical maternal health provider’ means a doula, lactation consultant, or lactation counselor.” In addition to any other qualification required by law or regulation, the Secretary of Defense shall ensure that to serve as a podiatrist in the Armed Forces, an individual must have successfully completed a three-year podiatric medicine and surgical residency. Subsection (a) shall apply with respect to an individual who is commissioned as an officer in the Armed Forces on or after the date that is one year after the date of the enactment of this Act [ Dec. 12, 2017 ].” Licensed or certified physical therapist assistants who meet the qualifications for physical therapist assistants specified in section 484.4 of title 42, Code of Federal Regulations, or any successor regulation, to furnish services under the supervision of a physical therapist. Licensed or certified occupational therapy assistants who meet the qualifications for occupational therapy assistants specified in such section 484.4, or any successor regulation, to furnish services under the supervision of an occupational therapist. The Secretary of Defense shall establish in regulations requirements for the supervision of physical therapist assistants and occupational therapy assistants, respectively, by physical therapists and occupational therapists, respectively. The Secretary of Defense shall update the CHAMPVA Policy Manual and other relevant manuals and subregulatory guidance of the Department of Defense to carry out the revisions and requirements of this section.” The Secretary of Defense shall establish a program to incentivize covered beneficiaries to participate in medical intervention programs established by the Secretary, such as comprehensive disease management programs, that may include lowering fees for enrollment in the TRICARE program by a certain percentage or lowering copayment and cost-share amounts for health care services during a particular year for covered beneficiaries with chronic diseases or conditions described in paragraph (2) who met participation milestones, as determined by the Secretary, in such medical intervention programs. Chronic diseases or conditions described in this paragraph may include diabetes, chronic obstructive pulmonary disease, asthma, congestive heart failure, hypertension, history of stroke, coronary artery disease, mood disorders, obesity, and such other diseases or conditions as the Secretary determines appropriate. The Secretary shall establish a program to incentivize lifestyle interventions for covered beneficiaries, such as smoking cessation and weight reduction, that may include lowering fees for enrollment in the TRICARE program by a certain percentage or lowering copayment and cost share amounts for health care services during a particular year for covered beneficiaries who met participation milestones, as determined by the Secretary, with respect to such lifestyle interventions, such as quitting smoking or achieving a lower body mass index by a certain percentage. The Secretary shall establish a program to incentivize the maintenance of a healthy lifestyle among covered beneficiaries, such as exercise and weight maintenance, that may include lowering fees for enrollment in the TRICARE program by a certain percentage or lowering copayment and cost-share amounts for health care services during a particular year for covered beneficiaries who met participation milestones, as determined by the Secretary, with respect to the maintenance of a healthy lifestyle, such as maintaining smoking cessation or maintaining a normal body mass index. Not later than January 1, 2020 , the Secretary shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on the implementation of the programs established under subsections (a), (b), and (c). A detailed description of the programs implemented under subsections (a), (b), and (c). improving health outcomes for covered beneficiaries; and lowering per capita health care costs for the Department of Defense. Not later than January 1, 2018 , the Secretary shall prescribe an interim final rule to carry out this section. In this section, the terms ‘covered beneficiary’ and ‘TRICARE program’ have the meaning given those terms in section 1072 of title 10 , United States Code.” The Secretary of Defense shall ensure that beneficiaries under TRICARE Prime who are seeking an appointment for health care under TRICARE Prime shall obtain such an appointment within the health care access standards established under subsection (b), including through the use of health care providers in the preferred provider network of TRICARE Prime. Not later than 180 days after the date of the enactment of this Act [ Nov. 25, 2015 ], the Secretary shall establish health care access standards for the receipt of health care under TRICARE Prime, whether received at military medical treatment facilities or from health care providers in the preferred provider network of TRICARE Prime. Primary care, including pediatric care, maternity care, gynecological care, and other subcategories of primary care. Specialty care, including behavioral health care and other subcategories of specialty care. The Secretary may modify the health care access standards established under paragraph (1) whenever the Secretary considers the modification of such standards appropriate. The Secretary shall publish the health care access standards established under paragraph (1), and any modifications to such standards, in the Federal Register and on a publicly accessible Internet website of the Department of Defense. The Secretary shall continuously monitor the ability of beneficiaries under TRICARE Prime to receive an appointment for specialty behavioral health care under TRICARE Prime within the access standards established under subsection (b)(2)(B) for such health care. Access to specialty behavioral health care in that State fails to meet the access standards established under subsection (b)(2)(B) for more than 12 consecutive months. The expanded accreditation standards are adequate to ensure quality of care. The Secretary may include in expanded behavioral health accreditation standards under subparagraph (A) appropriate credentials issued by State-level organizations. If the Secretary expands behavioral health accreditation standards under subparagraph (A), the Secretary shall provide to the Committees on Armed Services of the Senate and the House of Representatives a briefing on such expansion, including how such expansion affects access to specialty behavioral health care. If the Secretary makes a determination under clause (i) of subparagraph (A), but does not make a determination under clause (ii) of such subparagraph, the Secretary shall submit to the Committees on Armed Services of the Senate and the House of Representatives a notice explaining both such determinations. The authority of the Secretary under this subsection shall terminate on January 1, 2028 . The term ‘TRICARE Prime’ means the managed care option of the TRICARE program. The term ‘TRICARE program’ has the meaning given that term in section 1072(7) of title 10 , United States Code.” The Secretary of Defense shall ensure that covered beneficiaries under the TRICARE program who are covered under a health plan under such program are able to seamlessly access health care under such health plan in each TRICARE program region. Not later than 180 days after the date of the enactment of this Act [ Nov. 25, 2015 ], the Secretary shall prescribe regulations to carry out paragraph (1). establish a process for electronic notification of contractors responsible for administering the TRICARE program in each TRICARE region when any covered beneficiary intends to relocate between such regions; provide for the automatic electronic transfer between such contractors of information relating to covered beneficiaries who are relocating between such regions, including demographic, enrollment, and claims information; and arriving at the location to which the covered beneficiary has relocated; and initiating a request for a new primary health care provider. publish information on any modifications made pursuant to subsection (a) with respect to the ability of covered beneficiaries under the TRICARE program who are covered under a health plan under such program to access health care in each TRICARE region on the primary Internet website of the Department that is available to the public; and ensure that such information is made available on the primary Internet website that is available to the public of each current contractor responsible for administering the TRICARE program. In this section, the terms ‘covered beneficiary’ and ‘TRICARE program’ have the meaning given such terms in section 1072 of title 10 , United States Code.” During the period preceding January 1, 2021 , for purposes of determining whether a mental health care professional is eligible for reimbursement under the TRICARE program as a TRICARE certified mental health counselor, an individual who holds a masters degree or doctoral degree in counseling from a program that is accredited by a covered institution shall be treated as holding such degree from a mental health counseling program or clinical mental health counseling program that is accredited by the Council for Accreditation of Counseling and Related Educational Programs. The Accrediting Commission for Community and Junior Colleges Western Association of Schools and Colleges (ACCJC-WASC). The Higher Learning Commission (HLC). The Middle States Commission on Higher Education (MSCHE). The New England Association of Schools and Colleges Commission on Institutions of Higher Education (NEASC-CIHE). The Southern Association of Colleges and Schools (SACS) Commission on Colleges. The WASC Senior College and University Commission (WASC-SCUC). The Accrediting Bureau of Health Education Schools (ABHES). The Accrediting Commission of Career Schools and Colleges (ACCSC). The Accrediting Council for Independent Colleges and Schools (ACICS). The Distance Education Accreditation Commission (DEAC). The term ‘TRICARE program’ has the meaning given that term in section 1072 of title 10 , United States Code.” Not later than one year after the date of the enactment of this Act [ Nov. 25, 2015 ], the Secretary of Defense shall develop a system by which any non-Department mental health care provider that meets eligibility criteria established by the Secretary relating to the knowledge described in paragraph (2) receives a mental health provider readiness designation from the Department of Defense. Knowledge and understanding with respect to the culture of members of the Armed Forces and family members and caregivers of members of the Armed Forces. Knowledge with respect to evidence-based treatments that have been approved by the Department for the treatment of mental health issues among members of the Armed Forces. The Secretary of Defense shall establish and update as necessary a publically available registry of all non-Department mental health care providers that are currently designated under subsection (a)(1). The Secretary shall update all lists maintained by the Secretary of non-Department mental health care providers that provide mental health care under the laws administered by the Secretary by indicating the providers that are currently designated under subsection (a)(1). specializes in mental health; is not a health care provider of the Department of Defense at a facility of the Department; and provides health care to members of the Armed Forces; and includes psychiatrists, psychologists, psychiatric nurses, social workers, mental health counselors, marriage and family therapists, and other mental health care providers designated by the Secretary of Defense.” The Secretary of Defense may establish cooperative health care agreements between military installations and local or regional health care systems. the Secretary of the military department concerned; representatives from the military installation selected for the agreement, including the TRICARE managed care support contractor with responsibility for such installation; and Federal, State, and local government officials; identify and analyze health care services available in the area in which the military installation is located, including such services available at a military medical treatment facility or in the private sector (or a combination thereof); determine the cost avoidance or savings resulting from innovative partnerships between the Department of Defense and the private sector; and determine the opportunities for and barriers to coordinating and leveraging the use of existing health care resources, including such resources of Federal, State, local, and private entities. A description of the agreement. Any cost avoidance, savings, or increases as a result of the agreement. A recommendation for continuing or ending the agreement. Nothing in this section shall be construed as authorizing the provision of health care services at military medical treatment facilities or other facilities of the Department of Defense to individuals who are not otherwise entitled or eligible for such services under chapter 55 of title 10, United States Code.” How many health care providers in TRICARE Prime service areas selected under paragraph (3)(A) are accepting new patients under each of TRICARE Standard and TRICARE Extra. How many health care providers in geographic areas in which TRICARE Prime is not offered are accepting patients under each of TRICARE Standard and TRICARE Extra. The availability of mental health care providers in TRICARE Prime service areas selected under paragraph (3)(C) and in geographic areas in which TRICARE Prime is not offered. The Secretary shall establish for purposes of the surveys required by paragraph (1) benchmarks for primary care and specialty care providers, including mental health care providers, to be utilized to determine the adequacy of the availability of health care providers to beneficiaries eligible for TRICARE. In the case of the surveys required by subparagraph (A) of that paragraph, in at least 20 TRICARE Prime service areas in the United States in each of fiscal years 2008 through 2015. In the case of the surveys required by subparagraph (B) of that paragraph, in 20 geographic areas in which TRICARE Prime is not offered and in which significant numbers of beneficiaries who are members of the Selected Reserve reside. In the case of the surveys required by subparagraph (C) of that paragraph, in at least 40 geographic areas. consult with representatives of TRICARE beneficiaries and health care and mental health care providers to identify locations where TRICARE Standard beneficiaries are experiencing significant levels of access-to-care problems under TRICARE Standard or TRICARE Extra; give a high priority to surveying health care and mental health care providers in such areas; and give a high priority to surveying beneficiaries and providers located in geographic areas with high concentrations of members of the Selected Reserve. Whether the provider is aware of the TRICARE program. What percentage of the provider’s current patient population uses any form of TRICARE. Whether the provider accepts patients for whom payment is made under the medicare program for health care and mental health care services. If the provider accepts patients referred to in subparagraph (C), whether the provider would accept additional such patients who are not in the provider’s current patient population. The surveys required by paragraph (1) shall include questions seeking information to determine from TRICARE beneficiaries whether they have difficulties in finding health care and mental health care providers willing to provide services under TRICARE Standard or TRICARE Extra. that currently accept TRICARE Standard or TRICARE Extra beneficiaries as patients under TRICARE Standard in each TRICARE area as of the date of completion of the review; and that would accept TRICARE Standard or TRICARE Extra beneficiaries as new patients under TRICARE Standard or TRICARE Extra, as applicable, within a reasonable time after the date of completion of the review; and the actions taken by the Department of Defense to ensure ready access of TRICARE Standard beneficiaries to health care and mental health care under TRICARE Standard in each TRICARE area, including any pending or resolved requests for waiver of payment limits in order to improve access to health care or mental health care in a specific geographic area. An analysis of the adequacy of the surveys under subsection (a). An identification of any impediments to achieving adequacy of availability of health care and mental health care under TRICARE Standard or TRICARE Extra. An assessment of the adequacy of Department of Defense education programs to inform health care and mental health care providers about TRICARE Standard and TRICARE Extra. An assessment of the adequacy of Department of Defense initiatives to encourage health care and mental health care providers to accept patients under TRICARE Standard and TRICARE Extra. An assessment of the adequacy of information available to TRICARE Standard beneficiaries to facilitate access by such beneficiaries to health care and mental health care under TRICARE Standard and TRICARE Extra. An assessment of any need for adjustment of health care and mental health care provider payment rates to attract participation in TRICARE Standard by appropriate numbers of health care and mental health care providers. An assessment of the adequacy of Department of Defense programs to inform members of the Selected Reserve about the TRICARE Reserve Select program. An assessment of the ability of TRICARE Reserve Select beneficiaries to receive care in their geographic area. This section shall take effect on October 1, 2007 . Section 723 of the National Defense Authorization Act for Fiscal Year 2004 ( 10 U.S.C. 1073 note) is repealed, effective as of October 1, 2007 . The term ‘TRICARE Extra’ means the option of the TRICARE program under which TRICARE Standard beneficiaries may obtain discounts on cost-sharing as a result of using TRICARE network providers. The term ‘TRICARE Prime’ means the managed care option of the TRICARE program. The term ‘TRICARE Prime service area’ means a geographic area designated by the Department of Defense in which managed care support contractors develop a managed care network under TRICARE Prime. The term ‘TRICARE Standard’ means the option of the TRICARE program that is also known as the Civilian Health and Medical Program of the Uniformed Services, as defined in section 1072(4) of title 10 , United States Code. The term ‘TRICARE Reserve Select’ means the option of the TRICARE program that allows members of the Selected Reserve to enroll in TRICARE Standard, pursuant to section 1076d of title 10 , United States Code. The term ‘member of the Selected Reserve’ means a member of the Selected Reserve of the Ready Reserve of a reserve component of the Armed Forces. The term ‘United States’ means the United States (as defined in section 101(a) of title 10 , United States Code), its possessions (as defined in such section), and the Commonwealth of Puerto Rico.” Each military medical treatment facility. Each military quarters housing medical hold personnel. Each military quarters housing medical holdover personnel. The purpose of an inspection under this subsection is to ensure that the facility or quarters concerned meets acceptable standards for the maintenance and operation of medical facilities, quarters housing medical hold personnel, or quarters housing medical holdover personnel, as applicable. Generally accepted standards for the accreditation of medical facilities, or for facilities used to quarter individuals with medical conditions that may require medical supervision, as applicable, in the United States. Where appropriate, standards under the Americans with Disabilities Act of 1990 ( 42 U.S.C. 12101 et seq.). the commander of such facility or quarters, as applicable, shall submit to the Secretary a detailed plan to correct the deficiency; and the Secretary shall reinspect such facility or quarters, as applicable, not less often than once every 180 days until the deficiency is corrected. An inspection of a facility or quarters under this subsection is in addition to any inspection of such facility or quarters under subsection (a). acceptable standards for the maintenance and operation of such facilities or quarters, as the case may be; and where appropriate, standards under the Americans with Disabilities Act of 1990 [ 42 U.S.C. 12101 et seq.]; and the comprehensive implementation of the standards adopted under paragraph (1) at the earliest date practicable.” The Regional Director of each region under the TRICARE program shall develop each year integrated, comprehensive requirements for the support of military treatment facilities in such region that is provided by contract civilian health care and administrative personnel under the TRICARE program. To ensure consistent standards of quality in the support of military treatment facilities by contract civilian health care personnel under the TRICARE program. To identify targeted, actionable opportunities throughout each region of the TRICARE program for the most efficient and cost effective delivery of health care and support of military treatment facilities. To ensure the most effective use of various available contracting methods in securing support of military treatment facilities by civilian health care personnel under the TRICARE program, including resource-sharing and clinical support agreements, direct contracting, and venture capital investments. The Secretary of Defense shall take appropriate actions to facilitate and enhance the support of military treatment facilities under the TRICARE program in order to assure maximum quality and productivity. consistent credentialing requirements among military treatment facilities; consistent performance standards for private sector companies providing health care staffing services to military treatment facilities and clinics, including, at a minimum, those standards established for accreditation of health care staffing firms by the Joint Commission on the Accreditation of Health Care Organizations Health Care Staffing Standards; and financial stability; medical management; continuity of operations; training; employee retention; access to contractor data; and fraud prevention; ensure the availability of adequate and sustainable funding support for projects which produce a return on investment to the military treatment facilities; ensure that a portion of any return on investment is returned to the military treatment facility to which such savings are attributable; remove financial disincentives for military treatment facilities and civilian contractors to initiate and sustain agreements for the support of military treatment facilities by such contractors under the TRICARE program; provide for a consistent methodology across all regions of the TRICARE program for developing cost benefit analyses of agreements for the support of military treatment facilities by civilian contractors under the TRICARE program based on actual cost and utilization data within each region of the TRICARE program; and provide for a system for monitoring the performance of significant projects for support of military treatment facilities by a civilian contractor under the TRICARE program. Repealed. Pub. L. 112–81, div. A, title X, § 1062(d)(3) , Dec. 31, 2011 , 125 Stat. 1585 .] This section shall take effect on October 1, 2006 .” identifying health care providers who will participate in the TRICARE program and provide the TRICARE Standard option under that program; communicating with beneficiaries who receive the TRICARE Standard option; outreach to community health care providers to encourage their participation in the TRICARE program; and publication of information that identifies health care providers in the TRICARE region concerned who provide the TRICARE Standard option. In this section, the term ‘TRICARE Standard’ or ‘TRICARE standard option’ means the Civilian Health and Medical Program of the Uniformed Services option under the TRICARE program.” an officer of the Armed Forces in a general or flag officer grade; a civilian employee of the Department of Defense in the Senior Executive Service; or a civilian employee of the Federal Government in a department or agency other than the Department of Defense, or a civilian working in the private sector, who has experience in a position comparable to an officer described in subparagraph (A) or a civilian employee described in subparagraph (B); and has at least 10 years of experience, or equivalent expertise or training, in the military health care system, managed care, and health care policy and administration. In this section, the term ‘TRICARE program’ has the meaning given such term in section 1072(7) of title 10 , United States Code.” Not later than October 1, 2001 , the Secretary of Defense shall implement a system to simplify and make accessible through the use of the Internet, through commercially available systems and products, critical administrative processes within the military health care system and the TRICARE program. The purposes of the system shall be to enhance efficiency, improve service, and achieve commercially recognized standards of performance. shall comply with patient confidentiality and security requirements, and incorporate data requirements, that are currently widely used by insurers under medicare and commercial insurers; the availability and scheduling of appointments; the filing, processing, and payment of claims; marketing and information initiatives; the continuation of enrollments without expiration; the portability of enrollments nationwide; education of beneficiaries regarding the military health care system and the TRICARE program; and education of health care providers regarding such system and program; and may be implemented through a contractor under TRICARE Prime. The Secretary shall implement the system required by subsection (a) in at least one region under the TRICARE program. Not later than March 15, 2001 , the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and the House of Representatives a plan to provide portability and reciprocity of benefits for all enrollees under the TRICARE program throughout all TRICARE regions. The Secretary shall initiate a program to maximize the use of military medical treatment facilities by improving the efficiency of health care operations in such facilities. In this section the term ‘TRICARE program’ has the meaning given such term in section 1072 of title 10 , United States Code.” obtain a nonavailability statement or preauthorization from a military medical treatment facility in order to receive the services from a civilian provider; or obtain a nonavailability statement for care in specialized treatment facilities outside the 200-mile radius of a military medical treatment facility. demonstrates that significant costs would be avoided by performing specific procedures at the affected military medical treatment facility or facilities; determines that a specific procedure must be provided at the affected military medical treatment facility or facilities to ensure the proficiency levels of the practitioners at the facility or facilities; or determines that the lack of nonavailability statement data would significantly interfere with TRICARE contract administration; the Secretary provides notification of the Secretary’s intent to grant a waiver under this subsection to covered beneficiaries who receive care at the military medical treatment facility or facilities that will be affected by the decision to grant a waiver under this subsection; the Secretary notifies the Committees on Armed Services of the House of Representatives and the Senate of the Secretary’s intent to grant a waiver under this subsection, the reason for the waiver, and the date that a nonavailability statement will be required; and 60 days have elapsed since the date of the notification described in paragraph (3). Subsection (b) shall not apply with respect to maternity care. The date that a new contract entered into by the Secretary to provide health care services under TRICARE Standard takes effect. The date that is two years after the date of the enactment of the National Defense Authorization Act for Fiscal Year 2002 [ Dec. 28, 2001 ].”. may include a plan for an incentive-based formulary for military medical treatment facilities and contractors of TRICARE retail pharmacies and the national mail-order pharmacy; and A uniform formulary for such facilities and contractors. A centralized database that integrates the patient databases of pharmacies of military medical treatment facilities and contractor retail and mail-order programs to implement automated prospective drug utilization review systems. A system-wide drug benefit for covered beneficiaries under chapter 55 of title 10, United States Code, who are entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act ( 42 U.S.C. 1395c et seq.). The Secretary shall submit the plan required under subsection (a) not later than March 1, 1999 . the plan required under subsection (a) is submitted; and the Secretary implements cost-saving reforms with respect to the military and contractor retail and mail order pharmacy system.” Not later than April 1, 2001 , the Secretary of Defense shall implement, with respect to eligible individuals described in subsection (e), the redesign of the pharmacy system under TRICARE (including the mail-order and retail pharmacy benefit under TRICARE) to incorporate ‘best business practices’ of the private sector in providing pharmaceuticals, as developed under the plan described in section 703 [set out as a note above]. The same coverage for pharmacy services and the same requirements for cost sharing and reimbursement as are applicable under section 1086 of title 10 , United States Code, shall apply with respect to the program required by subsection (a). An analysis of the costs of the implementation of the redesign of the pharmacy system under TRICARE and to the eligible individuals who participate in the system. An assessment of the extent to which the implementation of such system satisfies the requirements of the eligible individuals for the health care services available under TRICARE. An assessment of the effect, if any, of the implementation of the system on military medical readiness. A description of the rate of the participation in the system of the individuals who were eligible to participate. An evaluation of any other matters that the Secretary considers appropriate. The Secretary shall submit two reports on the results of the evaluation under subsection (c), together with the evaluation, to the Committee on Armed Services of the Senate and the Committee on Armed Services of the House of Representatives. The first report shall be submitted not later than December 31, 2001 , and the second report shall be submitted not later than December 31, 2003 . is 65 years of age or older; is entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act ( 42 U.S.C. 1395c et seq.); and except as provided in paragraph (2), is enrolled in the supplemental medical insurance program under part B of such title XVIII ( 42 U.S.C. 1395j et seq.). Paragraph (1)(C) shall not apply in the case of an individual who, before April 1, 2001 , has attained the age of 65 and did not enroll in the program described in such paragraph.” Beginning not later than October 1, 1998 , the Secretary of Defense shall competitively procure from private-sector sources, or other sources outside of the Department of Defense, all ophthalmic services related to the provision of single vision and multivision eyeware [sic] for members of the Armed Forces, retired members, and certain covered beneficiaries under chapter 55 of title 10, United States Code, who would otherwise receive such ophthalmic services through the Department of Defense. is necessary to meet the readiness requirements of the Armed Forces; or is more cost effective. Subsection (a) shall not apply to orders for ophthalmic services received on or before September 30, 1998 .” The term ‘administering Secretaries’ means the Secretary of Defense, the Secretary of Homeland Security, and the Secretary of Health and Human Services. The term ‘agreement’ means the agreement required under section 722(b) between the Secretary of Defense and a designated provider. The term ‘capitation payment’ means an actuarially sound payment for a defined set of health care services that is established on a per enrollee per month basis. The term ‘covered beneficiary’ means a beneficiary under chapter 55 of title 10, United States Code, other than a beneficiary under section 1074(a) of such title. The term ‘designated provider’ means a public or nonprofit private entity that was a transferee of a Public Health Service hospital or other station under section 987 of the Omnibus Budget Reconciliation Act of 1981 ( Public Law 97–35 ; 42 U.S.C. 248b ) and that, before the date of the enactment of this Act [ Sept. 23, 1996 ], was deemed to be a facility of the uniformed services for the purposes of chapter 55 of title 10, United States Code. The term includes any legal successor in interest of the transferee. The term ‘enrollee’ means a covered beneficiary who enrolls with a designated provider. The term ‘health care services’ means the health care services provided under the health plan known as the ‘TRICARE PRIME’ option under the TRICARE program. The term ‘Secretary’ means the Secretary of Defense. The term ‘TRICARE program’ means the managed health care program that is established by the Secretary of Defense under the authority of chapter 55 of title 10, United States Code, principally section 1097 of such title, and includes the competitive selection of contractors to financially underwrite the delivery of health care services under the Civilian Health and Medical Program of the Uniformed Services. The health care delivery system of the uniformed services shall include the designated providers. After consultation with the other administering Secretaries, the Secretary of Defense shall negotiate and enter into an agreement with each designated provider under which the designated provider will provide health care services in or through managed care plans to covered beneficiaries who enroll with the designated provider. The agreement shall be entered into on a sole source basis. The Federal Acquisition Regulation, except for those requirements regarding competition, issued pursuant to section 1303(a) of title 41 , United States Code[,] shall apply to the agreements as acquisitions of commercial items. The implementation of an agreement is subject to availability of funds for such purpose. The date on which a managed care support contract under the TRICARE program is implemented in the service area of the designated provider. October 1, 1997 . The Secretary may modify the effective date established under paragraph (1) for an agreement to permit a transition period of not more than six months between the date on which the agreement is executed by the parties and the date on which the designated provider commences the delivery of health care services under the agreement. The Secretary shall extend the participation agreement of a designated provider in effect immediately before the date of the enactment of this Act [ Sept. 23, 1996 ] under section 718(c) of the National Defense Authorization Act for Fiscal Year 1991 ( Public Law 101–510 ; [former] 42 U.S.C. 248c [note]) until the agreement required by this section takes effect under subsection (c), including any transitional period provided by the Secretary under paragraph (2) of such subsection. The Secretary may not reduce the size of the service area of a designated provider below the size of the service area in effect as of September 30, 1996 . Unless otherwise agreed upon by the Secretary and a designated provider, the designated provider shall comply with necessary and appropriate administrative requirements established by the Secretary for other providers of health care services and requirements established by the Secretary of Health and Human Services for risk-sharing contractors under section 1876 of the Social Security Act ( 42 U.S.C. 1395mm ). The Secretary and the designated provider shall determine and apply only such administrative requirements as are minimally necessary and appropriate. A designated provider shall not be required to comply with a law or regulation of a State government requiring licensure as a health insurer or health maintenance organization. A designated provider may not contract out more than five percent of its primary care enrollment without the approval of the Secretary, except in the case of primary care contracts between a designated provider and a primary care contractor in force on the date of the enactment of this Act [ Sept. 23, 1996 ]. A designated provider shall be treated as part of the Department of Defense for purposes of section 8126 of title 38 , United States Code, in connection with the provision by the designated provider of health care services to covered beneficiaries pursuant to the participation agreement of the designated provider under section 718(c) of the National Defense Authorization Act for Fiscal Year 1991 ( Public Law 101–510 ; [former] 42 U.S.C. 248c note) or pursuant to the agreement entered into under subsection (b). A designated provider shall offer to enrollees the health benefit option prescribed and implemented by the Secretary under section 731 of the National Defense Authorization Act for Fiscal Year 1994 ( Public Law 103–160 ; 10 U.S.C. 1073 note), including accompanying cost-sharing requirements. The date on which health care services within the health care delivery system of the uniformed services are rendered through the TRICARE program in the region in which the designated provider operates. October 1, 1997 . The Secretary may establish a later date under subsection (b)(2) or prescribe reduced cost-sharing requirements for enrollees. During fiscal year 1997, the number of covered beneficiaries who are enrolled in managed care plans offered by designated providers may not exceed the number of such enrollees as of October 1, 1995 . The Secretary may waive the limitation under paragraph (1) if the Secretary determines that additional enrollment authority for a designated provider is required to accommodate covered beneficiaries who are dependents of members of the uniformed services entitled to health care under section 1074(a) of title 10 , United States Code. For each fiscal year beginning after September 30, 1997 , the number of enrollees in managed care plans offered by designated providers may not exceed 110 percent of the number of such enrollees as of the first day of the immediately preceding fiscal year. The Secretary may waive this limitation as provided in subsection (a)(2). An enrollee in the managed care plan of a designated provider as of September 30, 1997 , or such earlier date as the designated provider and the Secretary may agree upon, shall continue receiving services from the designated provider pursuant to the agreement entered into under section 722 unless the enrollee disenrolls from the designated provider. Except as provided in subsection (e), the administering Secretaries may not disenroll such an enrollee unless the disenrollment is agreed to by the Secretary and the designated provider. Subject to paragraph (2), other covered beneficiaries may also receive health care services from a designated provider. do not have other primary health insurance coverage (other than Medicare coverage) covering basic primary care and inpatient and outpatient services; subject to the limitation in subparagraph (B), have other primary health insurance coverage (other than Medicare coverage) covering basic primary care and inpatient and outpatient services; or are enrolled in the direct care system under the TRICARE program, regardless of whether the covered beneficiaries were users of the health care delivery system of the uniformed services in prior years. For each fiscal year beginning after September 30, 2003 , the number of covered beneficiaries newly enrolled by designated providers pursuant to clause (ii) of subparagraph (A) during such fiscal year may not exceed 10 percent of the total number of the covered beneficiaries who are newly enrolled under such subparagraph during such fiscal year. on the date of enrollment with a designated provider pursuant to paragraph (2)(A)(i); or on such date of enrollment and during the period after such date while the beneficiary is enrolled with the designated provider. Except as provided in paragraph (2), if a covered beneficiary who desires to enroll in the managed care program of a designated provider is also entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act ( 42 U.S.C. 1395c et seq.), the covered beneficiary shall elect whether to receive health care services as an enrollee or under part A of title XVIII of the Social Security Act. The Secretary may disenroll an enrollee who subsequently violates the election made under this subsection and receives benefits under part A of title XVIII of the Social Security Act. After September 30, 2012 , a covered beneficiary (other than a beneficiary under section 1079 of title 10 , United States Code) who is also entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act [ 42 U.S.C. 1395c et seq.] due to age may not enroll in the managed care program of a designated provider unless the beneficiary was enrolled in that program on September 30, 2012 . The Secretary shall provide, in a timely manner, a designated provider with an accurate list of covered beneficiaries within the marketing area of the designated provider to whom the designated provider may offer enrollment. The Secretary of Defense shall conduct a demonstration program under which covered beneficiaries shall be permitted to enroll at any time in a managed care plan offered by a designated provider consistent with the enrollment requirements for the TRICARE Prime option under the TRICARE program, but without regard to the limitation in subsection (b). The demonstration program under this subsection shall cover designated providers, selected by the Secretary of Defense, and the service areas of the designated providers. The demonstration program carried out under this section shall commence on October 1, 1999 , and end on September 30, 2001 . Not later than March 15, 2001 , the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on the demonstration program carried out under this subsection. The report shall include, at a minimum, an evaluation of the benefits of the open enrollment opportunity to covered beneficiaries and a recommendation on whether to authorize open enrollments in the managed care plans of designated providers permanently. Subject to subsection (b), the Secretary shall require a private facility or health care provider that is a health care provider under the Civilian Health and Medical Program of the Uniformed Services to apply the payment rules described in section 1074(c) of title 10 , United States Code, in imposing charges for health care that the private facility or provider provides to enrollees of a designated provider. The payment rules imposed under subsection (a) shall be subject to such modifications as the Secretary considers appropriate. The Secretary may authorize a lower rate than the maximum rate that would otherwise apply under subsection (a) if the lower rate is agreed to by the designated provider and the private facility or health care provider. The Secretary shall prescribe regulations to implement this section after consultation with the other administering Secretaries. Unless otherwise agreed to by the Secretary and a designated provider, the form of payment for health care services provided by a designated provider shall be on a full risk capitation payment basis. The capitation payments shall be negotiated and agreed upon by the Secretary and the designated provider. In addition to such other factors as the parties may agree to apply, the capitation payments shall be based on the utilization experience of enrollees and competitive market rates for equivalent health care services for a comparable population to such enrollees in the area in which the designated provider is located. Total capitation payments for health care services to a designated provider shall not exceed an amount equal to the cost that would have been incurred by the Government if the enrollees had received such health care services through a military treatment facility, the TRICARE program, or the Medicare program, as the case may be. In establishing the ceiling rate for enrollees with the designated providers who are also eligible for the Civilian Health and Medical Program of the Uniformed Services, the Secretary of Defense shall take into account the health status of the enrollees. The Secretary and a designated provider shall establish capitation payments on an annual basis, subject to periodic review for actuarial soundness and to adjustment for any adverse or favorable selection reasonably anticipated to result from the design of the program under this subtitle. After September 30, 1999 , the Secretary and a designated provider may mutually agree upon a new basis for calculating capitation payments. The amendments made by paragraphs (1), (2), and (3) of subsection (a) shall take effect on October 1, 1997 .” to each commander, deputy commander, and managed care coordinator of a military medical treatment facility of the Department of Defense, and any other person, who is selected to serve as a lead agent to coordinate the delivery of health care by military and civilian providers under the TRICARE program; and to appropriate members of the support staff of the treatment facility who will be responsible for daily operation of the TRICARE program. No person may be assigned as the commander, deputy commander, or managed care coordinator of a military medical treatment facility or as a TRICARE lead agent or senior member of the staff of a TRICARE lead agent office until the Secretary of the military department concerned submits a certification to the Secretary of Defense that such person has completed the training described in subsection (a).” address the impact of the TRICARE program on members of the Armed Forces (whether in the regular or reserve components) and their dependents, military retirees and their dependents, and dependents of members on active duty with severe disabilities and chronic health care needs with regard to access, costs, and quality of health care services; identify noncatchment areas in which the health maintenance organization option of the TRICARE program is available or is proposed to become available; and an identification of the number of practitioners providing health care in military medical treatment facilities that were reported to the National Practitioner Data Bank during the year preceding the evaluation; and the current accreditation status of such facility, including any recommendations for corrective action made by the relevant accrediting body; any policies or procedures implemented during such year by the Secretary of the military department concerned that were designed to improve patient safety, quality of care, and access to care at such facility; data on surgical and maternity care outcomes during such year; data on appointment wait times during such year; and data on patient safety, quality of care, and access to care as compared to standards established by the Department of Defense with respect to patient safety, quality of care, and access to care. The Secretary may use a federally funded research and development center to conduct the evaluation required by subsection (a). Not later than March 1, 1997 , and each March 1 thereafter, the Secretary shall submit to Congress a report describing the results of the evaluation under subsection (a) during the preceding year.” The Secretary of Defense shall prescribe and implement a health benefit option (and accompanying cost-sharing requirements) for covered beneficiaries eligible for health care under chapter 55 of title 10, United States Code, that is modelled on health maintenance organization plans offered in the private sector and other similar Government health insurance programs. The Secretary shall include, to the maximum extent practicable, the health benefit option required under this subsection as one of the options available to covered beneficiaries in all managed health care initiatives undertaken by the Secretary after December 31, 1994 . The Secretary shall offer covered beneficiaries who enroll in the health benefit option required under subsection (a) reduced out-of-pocket costs and a benefit structure that is as uniform as possible throughout the United States. The Secretary shall allow enrollees to seek health care outside of the option, except that the Secretary may prescribe higher out-of-pocket costs than are provided under section 1079 or 1086 of title 10, United States Code, for enrollees who obtain health care outside of the option. The health benefit option required under subsection (a) shall be administered so that the costs incurred by the Secretary under the TRICARE program are no greater than the costs that would otherwise be incurred to provide health care to the members of the uniformed services and covered beneficiaries who participate in the TRICARE program. The term ‘covered beneficiary’ means a beneficiary under chapter 55 of title 10, United States Code, other than a beneficiary under section 1074(a) of such title. The term ‘TRICARE program’ means the managed health care program that is established by the Secretary of Defense under the authority of chapter 55 of title 10, United States Code, principally section 1097 of such title, and includes the competitive selection of contractors to financially underwrite the delivery of health care services under the Civilian Health and Medical Program of the Uniformed Services. Not later than December 31, 1994 , the Secretary shall prescribe final regulations to implement the health benefit option required by subsection (a). In the case of managed health care contracts in effect or in final stages of acquisition as of December 31, 1994 , the Secretary may modify such contracts to incorporate the health benefit option required under subsection (a).” The terms ‘uniformed services’, ‘covered beneficiary’, ‘TRICARE Extra’, ‘TRICARE for Life’, ‘TRICARE Prime’, and ‘TRICARE Standard’, have the meaning given those terms in section 1072 of title 10 , United States Code, as amended by subsection (j). The term ‘TRICARE Select’ means the self-managed, preferred-provider network option under the TRICARE program established by section 1075 of such title, as added by subsection (a). The term ‘chronic conditions’ includes diabetes, chronic obstructive pulmonary disease, asthma, congestive heart failure, hypertension, history of stroke, coronary artery disease, mood disorders, and such other diseases or conditions as the Secretary considers appropriate. The term ‘high-value medications and services’ means prescription medications and clinical services for the management of chronic conditions that the Secretary determines would improve health outcomes and create health value for covered beneficiaries (such as preventive care, primary and specialty care, diagnostic tests, procedures, and durable medical equipment). The term ‘high-value provider’ means an individual or institutional health care provider that provides health care under the purchased care component of the TRICARE program and that consistently improves the experience of care, meets established quality of care and effectiveness metrics, and reduces the per capita costs of health care. The term ‘value-based health care methodology’ means a methodology for identifying specific prescription medications and clinical services provided under the TRICARE program for which reduction of copayments, cost shares, or both, would improve the management of specific chronic conditions because of the high value and clinical effectiveness of such medications and services for such chronic conditions.”