Sec. 701. TRICARE Preferred and other TRICARE reform
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Chapter 55 of title 10, United States Code, is amended by inserting after section 1074n the following new section: Not later than January 1, 2018, the Secretary of Defense shall establish a self-managed, preferred-provider network option under the TRICARE program. Such option shall be known as TRICARE Preferred . The Secretary shall establish TRICARE Preferred in all areas. Under TRICARE Preferred, eligible beneficiaries will not have restrictions on the freedom of choice of the beneficiary with respect to health care providers.
The beneficiary categories for purposes of eligibility to enroll in TRICARE Preferred and cost sharing requirements applicable to such category are as follows: An active-duty family member category that consists of beneficiaries who are covered by section 1079 of this title (as dependents of active duty members). A retired category that consists of beneficiaries covered by subsection
(c)of section 1086 of this title, other than Medicare-eligible beneficiaries described in subsection (d)(2) of such section. A reserve and young adult category that consists of beneficiaries who are covered by— section 1076d of this title; section 1076e; or section 1110b. A covered beneficiary who elects to participate in TRICARE Preferred shall enroll in such option under section 1099 of this title. The cost sharing requirements under TRICARE Preferred are as follows: With respect to beneficiaries in the active-duty family member category or the retired category by reason of being a member or former member of the uniformed services who originally enlists or is appointed in the uniformed services on or after January 1, 2018, or by reason of being a dependent of such a member, the cost sharing requirements shall be calculated pursuant to subsection (d)(1). Except as provided by subsection (e), with respect to beneficiaries described in subparagraph
(B)in the active-duty family member category or the retired category, the cost sharing requirements shall be calculated as if the beneficiary were enrolled in TRICARE Extra or TRICARE Standard as if TRICARE Extra or TRICARE Standard, as the case may be, were still being carried out by the Secretary. Beneficiaries described in this subparagraph are beneficiaries who are eligible to enroll in the TRICARE program by reason of being a member or former member of the uniformed services who originally enlists or is appointed in the uniformed services before January 1, 2018, or by reason of being a dependent of such a member. With respect to beneficiaries in the reserve and young adult category, the cost sharing requirements shall be calculated pursuant to subsection (d)(1) as if the beneficiary were in the active-duty family member category or the retired category, as applicable, except that the premiums calculated pursuant to sections 1076d, 1076e, or 1110b of this title, as the case may be, shall apply instead of any enrollment fee required under this section. Beneficiaries described in subsection (c)(1) enrolled in TRICARE Preferred shall be subject to cost-sharing requirements in accordance with the amounts and percentages under the following table during calendar year 2018 and as such amounts are adjusted under paragraph
(2)for subsequent years: TRICARE Preferred Active-Duty Family Member (Individual/Family) Retired (Individual/Family) Annual Enrollment $300 / $600 $425 / $850 Annual deductible $0 $0 Annual catastrophic cap $1,000 $3,000 Outpatient visit civilian network $15 primary care $25 primary care $25 specialty care $40 specialty care Out of network: 20% 25% of out of network ER visit civilian network $40 network $60 network 20% out of network Urgent care civilian network $20 network $40 network 20% out of network 25% out of network Ambulatory surgery civilian network $40 network $80 network 20% out of network 25% out of network Ambulance civilian network $15 $25 Durable medical equipment civilian network 10% 20% Inpatient visit civilian network $60 per network admission $125 per admission network 20% out of network 25% out of net work Inpatient skilled nursing/rehab civilian $20 per day network $50 per day network $50 per day out of network $300 per day or 20% of billed charges out of network Each dollar amount expressed as a fixed dollar amount in the table set forth in paragraph (1), and the amounts determined under subsection (e), shall be annually indexed to the amount by which retired pay is increased under section 1401a of this title, rounded to the next lower multiple of $1. The remaining amount above such multiple of $1 shall be carried over to, and accumulated with, the amount of the increase for the subsequent year or years and made when the aggregate amount of increases carried over under this clause for a year is $1 or more. Enrollment fees, deductible amounts, and catastrophic caps under this section are on a calendar-year basis. Subject to paragraph (3), and in accordance with subsection (d)(2), the Secretary shall establish an annual enrollment fee for beneficiaries described in subsection (c)(2)(B) in the retired category who enroll in TRICARE Preferred (other than such beneficiaries covered by paragraph (2)). Such enrollment fee shall be $100 for an individual and $200 for a family. The enrollment fee established pursuant to paragraph
(1)for beneficiaries described in subsection (c)(2)(B) in the retired category shall not apply with respect to the following beneficiaries: Retired members and the family members of such members covered by paragraph
(1)of section 1086(c) of this title by reason of being retired under chapter 61 of this title or being a dependent of such a member. Survivors covered by paragraph
(2)of such section 1086(c). The Secretary may not establish an annual enrollment fee under paragraph
(1)until 90 days has elapsed following the date on which the Comptroller General of the United States is required to submit the review under paragraph (4). Not later than February 1, 2020, the Comptroller General of the United States shall submit to the Committees on Armed Services of the House of Representatives and the Senate a review of the following: Whether health care coverage for covered beneficiaries has changed since the enactment of this section. Whether covered beneficiaries are able to obtain appointments for health care according to the access standards established by the Secretary of Defense. The percent of network providers that accept new patients under the TRICARE program. The satisfaction of beneficiaries under TRICARE Preferred. As part of the administration of TRICARE Prime and TRICARE Preferred, the Secretary shall publish on a publically available Internet website of the Department of Defense data on all measures required by section 711 of the National Defense Authorization Act for Fiscal Year 2017. The published measures shall be updated not less frequently than quarterly. Nothing in this section may be construed as affecting the availability of TRICARE Prime and TRICARE for Life. In this section, terms active-duty family member category , retired category , and reserve and young adult category mean the respective categories of TRICARE Preferred enrollment described in subsection (b). . The table of sections at the beginning of chapter 55 of title 10, United States Code, is amended by inserting after the item relating to section 1074n, the following new item: 1075. TRICARE Preferred. . Chapter 55 of title 10, United States Code, is amended by inserting after section 1075, as added by subsection (a), the following new section: The cost sharing requirements under TRICARE Prime are as follows: There are no cost-sharing requirements for beneficiaries who are covered by section 1074(a) of this title. With respect to beneficiaries in the active-duty family member category or the retired category (as described in section 1075(b)(1) of this title) by reason of being a member or former member of the uniformed services who originally enlists or is appointed in the uniformed services on or after January 1, 2018, or by reason of being a dependent of such a member, the cost-sharing requirements shall be calculated pursuant to subsection (b)(1). With respect to beneficiaries described in subparagraph
(B)in the active-duty family member category or the retired category (as described in section 1075(b)(1) of this title), the cost-sharing requirements shall be calculated in accordance with the other provisions of this chapter without regard to subsection (b). Beneficiaries described in this subparagraph are beneficiaries who are eligible to enroll in the TRICARE program by reason of being a member or former member of the uniformed services who originally enlists or is appointed in the uniformed services before January 1, 2018, or by reason of being a dependent of such a member. Beneficiaries described in subsection (a)(2) enrolled in TRICARE Prime shall be subject to cost-sharing requirements in accordance with the amounts and percentages under the following table during calendar year 2018 and as such amounts are adjusted under paragraph
(2)for subsequent years: TRICARE Prime Active-Duty Family Member (Individual/Family) Retired (Individual/Family) 1: Deductibles and cost-sharing does apply to TRICARE Prime beneficiaries that seek care in the civilian network care through the point-of-service option (without a referral). Annual deductible is $300 individual and $600 family. Cost-sharing for covered inpatient and outpatient services are 50% of the TRICARE allowable charges. Annual Enrollment $180 / $360 $325 / $650 Annual deductible No 1 No 1 Annual catastrophic cap $1,000 $3,000 per family Outpatient visit civilian network $0 with authorization $20 primary care $30 specialty care ER visit civilian network $0 $50 network Urgent care civilian network $0 $30 network Ambulatory surgery civilian network $0 with authorization $60 network with authorization Ambulance civilian network $0 $20 Durable medical equipment civilian network $0 with authorization 20% Inpatient visit civilian network $0 with authorization $100 network per admission with authorization Inpatient skilled nursing/rehab civilian $0 with authorization $30 per day network with authorization Each dollar amount expressed as a fixed dollar amount in the table set forth in paragraph
(1)shall be annually indexed to the amount by which retired pay is increased under section 1401a of this title, rounded to the next lower multiple of $1. The remaining amount above such multiple of $1 shall be carried over to, and accumulated with, the amount of the increase for the subsequent year or years and made when the aggregate amount of increases carried over under this clause for a year is $1 or more. Enrollment fees, deductible amounts, and catastrophic caps under this section are on a calendar-year basis. . The table of sections at the beginning of chapter 55 of title 10, United States Code, is amended by inserting after the item relating to section 1075, as added by subsection (a), the following new item: 1075a. TRICARE Prime: cost sharing. . Section 1073 of title 10, United States Code, is amended by adding at the end the following new subsection: The Secretary of Defense shall ensure that the enrollment status of covered beneficiaries is portable between or among TRICARE program regions of the United States and that effective procedures are in place for automatic electronic transfer of information between or among contractors responsible for administration in such regions and prompt communication with such beneficiaries. Each covered beneficiary enrolled in TRICARE Prime who has relocated the beneficiary’s primary residence to a new area in which enrollment in TRICARE Prime is available shall be able to obtain a new primary health care manager or provider within 10 days of the relocation and associated request for such manager or provider. . Beginning on January 1, 2018, the Secretary of Defense may not carry out TRICARE Standard and TRICARE Extra under the TRICARE program. The Secretary shall ensure that any individual who is covered under TRICARE Standard or TRICARE Extra as of December 31, 2017, enrolls in TRICARE Prime, TRICARE Preferred, or TRICARE for Life, as the case may be, as of January 1, 2018, for the individual to continue coverage under the TRICARE program. Not later than June 1, 2017, the Secretary of Defense shall submit to the Committees on Armed Services of the House of Representatives and the Senate an implementation plan to improve access to health care for TRICARE beneficiaries pursuant to the amendments made by this section. The plan under paragraph
(1)shall— ensure that at least 85 percent of the beneficiary population under TRICARE Preferred is covered by the network by January 1, 2018; establish access standards for appointments for health care; establish mechanisms for monitoring compliance with access standards; establish health care provider-to-beneficiary ratios; monitor on a monthly basis complaints by beneficiaries with respect to network adequacy and the availability of health care providers; establish requirements for mechanisms to monitor the responses to complaints by beneficiaries; mechanisms to evaluate the quality metrics of the network providers established under section 711; any recommendations for legislative action the Secretary determines necessary to carry out the plan; and any other elements the Secretary determines appropriate. Not later than December 1, 2017, the Comptroller General of the United States shall submit to the Committees on Armed Services of the House of Representatives and the Senate a review of the implementation plan of the Secretary under paragraph
(1)of subsection (e), including an assessment of the adequacy of the plan in meeting the elements specified in paragraph
(2)of such subsection. Not later than September 1, 2017, the Comptroller General shall submit to the Committees on Armed Services of the House of Representatives and the Senate a review of the network established under TRICARE Extra, including the following: An identification of the percent of beneficiaries who are covered by the network. An assessment of the extent to which beneficiaries are able to obtain appointments under TRICARE extra. The percent of network providers under TRICARE Extra that accept new patients under the TRICARE program. An assessment of the satisfaction of beneficiaries under TRICARE Extra. In this section: 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 (h). The term TRICARE Preferred means the self-managed, preferred-provider network option under the TRICARE program established by section 1075 of such title, as added by subsection (a). Title 10, United States Code, is amended as follows: Section 1072 is amended— by striking paragraph
(7)and inserting the following: The term TRICARE program means the various programs carried out by the Secretary of Defense under this chapter and any other provision of law providing for the furnishing of medical and dental care and health benefits to members and former members of the uniformed services and their dependents, including the following health plan options: TRICARE Prime. TRICARE Preferred. TRICARE for Life. ; and by adding at the end the following new paragraphs: The term TRICARE Extra means the preferred provider option of the TRICARE program made available prior to January 1, 2018, under which TRICARE Standard beneficiaries may obtain discounts on cost-sharing as a result of using TRICARE network providers. The term TRICARE Preferred the self-managed, preferred-provider network option under the TRICARE program established by section 1075 of this title. The term TRICARE for Life means the Medicare wraparound coverage option of the TRICARE program made available to the beneficiary by reason of section 1086(d) of this title. The term TRICARE Prime means the managed care option of the TRICARE program. The term TRICARE Standard means the TRICARE program made available prior to January 1, 2018, covering— medical care to which a dependent described in section 1076(a)(2) of this title is entitled; and health benefits contracted for under the authority of section 1079(a) of this title and subject to the same rates and conditions as apply to persons covered under that section. . Section 1076d is amended— in subsection (d)(1), by inserting after coverage. the following: Such premium shall apply instead of any enrollment fees required under section 1075 of this section. ; and in subsection (f), by striking paragraph
(2)and inserting the following new paragraph: The term TRICARE Reserve Select means the TRICARE Preferred self-managed, preferred-provider network option under section 1075 made available to beneficiaries by reason of this section and in accordance with subsection (d)(1). ; and by striking TRICARE Standard each place it appears (including in the heading of such section) and inserting TRICARE Reserve Select . Section 1076e is amended— in subsection (d)(1), by inserting after coverage. the following: Such premium shall apply instead of any enrollment fees required under section 1075 of this section. ; and in subsection (f), by striking paragraph
(2)and inserting the following new paragraph: The term TRICARE Retired Reserve means the TRICARE Preferred self-managed, preferred-provider network option under section 1075 made available to beneficiaries by reason of this section and in accordance with subsection (d)(1). ; in subsection (b), by striking TRICARE Standard coverage at and inserting TRICARE coverage at ; and by striking TRICARE Standard each place it appears (including in the heading of such section) and inserting TRICARE Retired Reserve . Section 1079a is amended— in the section heading, by striking and inserting CHAMPUS ; and TRICARE program by striking the Civilian Health and Medical Program of the Uniformed Services and inserting the TRICARE program . Section 1099(c) is amended by striking paragraph
(2)and inserting the following new paragraph: A plan under the TRICARE program. . Section 1110b(c)(1) is amended by inserting after (b). the following: Such premium shall apply instead of any enrollment fees required under section 1075 of this section. . The table of sections at the beginning of chapter 55 of title 10, United States Code, is further amended— in the item relating to section 1076d, by striking TRICARE Standard and inserting TRICARE Reserve Select ; in the item relating to section 1076e, by striking TRICARE Standard and inserting TRICARE Retired Reserve ; and in the item relating to section 1079a, by striking CHAMPUS and inserting TRICARE program . Any new language inserted or added to title 10, United States Code, by an amendment made by this subsection shall conform to the typeface and typestyle of the matter in which the language is so inserted or added. The amendments made by this section shall apply with respect to the provision of health care under the TRICARE program beginning on January 1, 2018.