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Code · BILL · 115th Congress · H.R. 5515 (Enrolled) — To authorize appropriations for fiscal year 2019 for military activities of the Department of Defense, for military c... · Sec. 714

Sec. 714. Streamlining of TRICARE Prime beneficiary referral process

205 words·~1 min read·/bill/115/hr/5515/enr/section-714·

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The Secretary of Defense shall streamline the process under section 1095f of title 10, United States Code, by which beneficiaries enrolled in TRICARE Prime are referred to the civilian provider network for inpatient or outpatient care under the TRICARE program. In carrying out the requirement in subsection (a), the Secretary shall meet the following objectives: The referral process shall model best industry practices for referrals from primary care managers to specialty care providers.
The process shall limit administrative requirements for enrolled beneficiaries. Beneficiary preferences for communications relating to appointment referrals using state-of-the-art information technology shall be used to expedite the process. There shall be effective and efficient processes to determine the availability of appointments at military medical treatment facilities and, when unavailable, to make prompt referrals to network providers under the TRICARE program. The requirement in subsection
(a)shall be implemented for referrals under TRICARE Prime in calendar year 2019. After 2019, the Secretary shall— evaluate the referral process described in subsection
(a)not less often than annually; and make appropriate improvements to the process in light of such evaluations. In this section, the terms TRICARE program and TRICARE Prime have the meaning given such terms in section 1072 of title 10, United States Code.
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