Sec. 726. Acquisition of medical support contracts for TRICARE program
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Beginning not later than January 1, 2018, the Secretary of Defense shall conduct a new competition of all medical support contracts with private sector entities under the TRICARE program, other than the overseas medical support contract, upon the expiration of each such contract and enter into new medical support contracts with private sector entities— to improve access to health care for covered beneficiaries; to improve health outcomes for covered beneficiaries; to improve the quality of health care received by covered beneficiaries; to enhance the experience of covered beneficiaries in receiving health care; and to lower per capita costs to the Department of Defense of health care provided to covered beneficiaries.
The Secretary may not exercise an option to extend any medical support contract with a private sector entity under the TRICARE program that would delay the award of a new medical support contract pursuant to the competition of that contract under subparagraph (A). Not later than one year after entering into a medical support contract under paragraph (1), the Secretary shall issue an open broad agency announcement to allow potential contractors under the TRICARE program to propose innovative ideas and solutions to meet the medical support contract needs of the Department under the TRICARE program.
A medical support contract awarded pursuant to the broad agency announcement issued under subparagraph
(A)shall be deemed to meet the requirements under section 2304 of title 10, United States Code, relating to the use of competitive procedures to procure services. Each contract entered into under subsection
(a)shall be competitively procured and automatically renewable for a period of not more than 10 years unless notice for termination is provided by either party not later than 180 days before such termination. The Secretary shall enter into under subsection
(a)a combination of local, regional, and national contracts to develop individual and institutional high-performing networks of health care providers. Each contract entered into under subsection
(a)shall, to the extent practicable, provide for the following: The maximization of flexibility in the design and configuration of networks of individual and institutional health care providers, including a focus on the development of high-performing networks of health care providers. The creation of an integrated medical management system between military treatment facilities and health care providers in the private sector that, when appropriate, effectively coordinates and integrates health care across the continuum of care. With respect to telehealth services— the maximization of the use of such services to provide real-time interactive communications between patients and health care providers and remote patient monitoring; and the use of standardized payment methods to reimburse health care providers for the provision of such services. The use of value-based reimbursement methodologies that transfer financial risk to health care providers and medical support contractors. The use of financial incentives for contractors and health care providers to receive an equitable share in the cost savings to the Department resulting from improvement in health outcomes for covered beneficiaries and the experience of covered beneficiaries in receiving health care. The use of incentives, emphasizing prevention and wellness, for covered beneficiaries receiving health care services from private sector entities to seek such services from high-value health care providers. The adoption of a streamlined process for enrollment of covered beneficiaries to receive health care and timely assignment of primary care managers to covered beneficiaries. The elimination of the requirement to receive authorization for a referral for specialty care services from the direct or purchased care component of the military health system. The use of incentives to encourage covered beneficiaries to participate in medical and lifestyle intervention programs. In entering into medical support contracts under subsection
(a)and implementing such contracts, the Secretary shall— assess the unique characteristics of providing health care services in rural, remote, or isolated locations, such as Alaska and Hawaii and locations in the contiguous 48 States; consider the various challenges inherent in developing robust networks of health care providers in those locations; and develop a provider reimbursement rate structure in those locations that ensures— timely access of covered beneficiaries to health care services; the delivery of high-quality primary and specialty care; improvement in health outcomes for covered beneficiaries; and an enhanced experience of care for covered beneficiaries. The Secretary of Defense may not modify existing medical support contracts under the TRICARE program in rural, remote, or isolated locations, such as Alaska and Hawaii and locations in the contiguous 48 States, or enter into new medical support contracts under subsection
(a)in those locations, until the Secretary certifies to the Committees on Armed Services of the Senate and the House of Representatives that medical support contracts in those locations will— establish individual and institutional provider networks that will ensure timely access to care for covered beneficiaries; and deliver high-quality care, better health outcomes, and a better experience of care for covered beneficiaries. Not later than January 1, 2019, the Comptroller General of the United States shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report that assesses the compliance of the Secretary of Defense with the requirements of this section. The report required by paragraph
(1)shall include an assessment of the following: Whether the approach of the Department of Defense to acquiring medical support contracts under this section would— improve access to care; improve health outcomes; improve the experience of care for covered beneficiaries; and lower per capita health care costs. Whether the Department has, in its requirements for medical support contracts entered into under this section, allowed for— maximum flexibility in network design and development; integrated medical management between military treatment facilities and network providers; the maximum use of the full range of telehealth services; the use of value-based reimbursement methods that transfer financial risk to health care providers and medical support contractors; the use of prevention and wellness incentives to encourage covered beneficiaries to seek health care services from high-value providers; a streamlined enrollment process and timely assignment of primary care managers; the elimination of the requirement to seek authorization for referrals for specialty care services; the use of incentives to encourage certain covered beneficiaries to engage in medical and lifestyle intervention programs; and the use of financial incentives for contractors and health care providers to receive an equitable share in cost savings resulting from improvements in health outcomes and the experience of care for covered beneficiaries. Whether the Department has developed a plan for continuous competition of medical support contracts to enable the Department to incorporate innovative ideas and solutions into those contracts. Whether the Department has considered, in developing requirements for medical support contracts, the following: The unique characteristics of providing health care services in rural, remote, or isolated locations, such as Alaska and Hawaii and locations in the contiguous 48 states. The various challenges inherent in developing robust networks of health care providers in those locations. A provider reimbursement rate structure in those locations that ensures— timely access of covered beneficiaries to health care services; the delivery of high-quality primary and specialty care; improvement in health outcomes for covered beneficiaries; and an enhanced experience of care for covered beneficiaries. 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 term high-performing networks of health care providers means networks of health care providers that, in addition to such other requirements as the Secretary may specify for purposes of this section, do the following: Deliver high quality health care as measured by leading health quality measurement organizations such as the National Committee for Quality Assurance and the Agency for Healthcare Research and Quality. Achieve greater efficiency in the delivery of health care by identifying and implementing within such network improvement opportunities that guide patients through the entire continuum of care, thereby reducing variations in the delivery of health care and preventing medical errors and duplication of medical services. Improve population-based health outcomes by using a team approach to deliver case management, prevention, and wellness services to high-need and high-cost patients. Focus on preventive care that emphasizes— early detection and timely treatment of disease; periodic health screenings; and education regarding healthy lifestyle behaviors. Coordinate and integrate health care across the continuum of care, connecting all aspects of the health care received by the patient, including the patient’s health care team. Facilitate access to health care providers, including— after-hours care; urgent care; and through telehealth appointments, when appropriate. Encourage patients to participate in making health care decisions. Use evidence-based treatment protocols that improve the consistency of health care and eliminate ineffective, wasteful health care practices.