Sec. 705. Authority for provisional TRICARE coverage for emerging health care products and services
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/bill/113/s/2410/pcs/section-705·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Section 1073 of title 10, United States Code, is amended by adding after subsection
(b)the following new subsection: The Secretary of Defense is authorized to provide provisional coverage or authorization of coverage under this chapter for health care products and services that have not been demonstrated to be safe and effective under this chapter as medically or psychologically necessary to prevent, diagnose, or treat a mental or physical illness, injury, or bodily malfunction but have been demonstrated to the satisfaction of the Secretary to be likely safe and effective health care products or services. In making a determination authorized by paragraph (1), the Secretary may consider— clinical trials published in refereed medical literature; formal technology assessments; national medical policy organization positions; national professional associations; national expert opinion organizations; and such other trustworthy evidence as the Secretary considers appropriate. In making a determination under paragraph (1), the Secretary may arrange for an evaluation from the Institute of Medicine of the National Academies of Sciences or such other independent entity as the Secretary shall select. Provisional coverage under paragraph
(1)for a product or service may be in effect not longer than five years, but may be terminated at any time before that time. Prior to the expiration of provisional coverage or authorization of coverage of a product or service pursuant to subparagraph (A), the Secretary shall determine the coverage or authorization of coverage, if any, that will follow coverage or authorization of coverage of such product or service, and take appropriate action to implement such determination. If implementation of such determinations requires legislative action, the Secretary shall make a timely recommendation to Congress regarding such legislative action. Prompt public notice shall be provided for each product or service that receives an affirmative provisional coverage or authorization of coverage determination under paragraph
(1)along with all terms and conditions associated with the determination. The public notice shall be through the website of the TRICARE program accessible by the public. All determinations under this subsection to provide, decline to provide, terminate, establish or disestablish terms and conditions, or take any other action shall be approved by the Assistant Secretary of Defense for Health Affairs based on professional medical judgment. Such determinations and actions are committed to agency discretion and are conclusive. .