Sec. 701. TRICARE Advantage demonstration program
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Not later than one year after the date of the enactment of this Act, the Secretary shall, in consultation with the Secretary of Health and Human Services, establish a demonstration program to enable applicable eligible individuals to enroll in Medicare Advantage plans. The demonstration program established under paragraph
(1)shall be carried out for a period of not less than five years. The Secretary shall competitively select one or more Medicare Advantage plans for which the Secretary of Health and Human Services has waived or modified requirements under section 1857(i) of the Social Security Act ( 42 U.S.C. 1395w-27(i) ) in market areas of the TRICARE program with large concentrations of beneficiaries eligible for TRICARE for Life (as determined by the Secretary) to participate in the demonstration program through the use of risk-bearing, capitated contracts with Medicare Advantage organizations. Each Medicare Advantage plan selected under paragraph
(1)shall meet the following requirements: The plan is an MA-PD plan (as defined in section 1860D-1(a)(3)(C) of the Social Security Act ( 42 U.S.C. 1395w-101(a)(3)(C) )). The plan has a minimum quality star rating of four or higher under section 1853(o)(4) of such Act ( 42 U.S.C. 1395w-23(o)(4) ). The plan and the Medicare Advantage organization offering the plan meet such other criteria as the Secretary determines appropriate for purposes of this section. The Secretary may include military treatment facilities as authorized providers for applicable eligible individuals enrolled in a Medicare Advantage plan participating in the demonstration program as a service provided by the Department of Defense. The Secretary may include coverage of pharmaceutical agents under the pharmacy benefits program under section 1074g of title 10, United States Code, as a coverage option for applicable eligible individuals enrolled in a Medicare Advantage plan participating in the demonstration program as a service provided by the Department of Defense. Unless an applicable eligible individual opts out, all applicable eligible individuals located in an area participating in the demonstration program shall be enrolled in a Medicare Advantage plan selected under subsection (b)(1). The Secretary and the Secretary of Health and Human Services shall jointly determine the appropriate distribution of costs and potential savings to the Department of Defense and the Department of Health and Human Services that result from the demonstration program. Not later than one year after the date of the enactment of this Act, the Secretary shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on the implementation by the Secretary of the demonstration program under this section. The report required by subparagraph
(A)shall include the following: A description of each Medicare Advantage plan participating in the demonstration program, disaggregated by market area of the TRICARE program (as determined by the Secretary). A description of covered benefits, premium rates, and copayments or cost sharing, if any, for each Medicare Advantage plan participating in the demonstration program in each such area. The number of applicable eligible individuals eligible to enroll and the number of applicable eligible individuals projected to enroll in each Medicare Advantage plan participating in the demonstration program in each such area. An assessment of projected average annual out-of-pocket costs, if any, for applicable eligible individuals enrolled in each Medicare Advantage plan participating in the demonstration program. A description of outcome metrics developed to measure quality of care, improved health outcomes, better access to care, and enhanced beneficiary experience under the demonstration program. Not later than four years after the date of the enactment of this Act, the Secretary shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report providing a comprehensive assessment of the demonstration program under this section. In this section: The term applicable eligible individual means an eligible individual (as defined in paragraph (2)) who is a Medicare Advantage eligible individual (as defined in section 1851(a)(3) of the Social Security Act ( 42 U.S.C. 1395w-21(a)(3) )). The term eligible individual means an individual eligible for health benefits under section 1086(d) of title 10, United States Code. The term Medicare Advantage organization has the meaning given that term in section 1859 of the Social Security Act ( 42 U.S.C. 1395w-28 ). The term Medicare Advantage plan means a health plan under part C of title XVIII of the Social Security Act ( 42 U.S.C. 1395w-21 et seq.). The term Secretary means the Secretary of Defense. The terms TRICARE program and TRICARE for Life have the meanings given those terms in section 1072 of title 10, United States Code. In order to implement expeditiously the demonstration program under this section, the Secretary may prescribe such changes to the regulations implementing the TRICARE program as the Secretary considers appropriate. The Secretary shall implement any changes prescribed under paragraph (1)— by prescribing an interim final rule; and not later than 180 days after prescribing such interim final rule and considering public comments with respect to such interim final rule, by prescribing a final rule. The Secretary of Health and Human Services may waive such requirements of titles XI and XVIII of the Social Security Act ( 42 U.S.C. 1301 et seq.; 1395 et seq.) as may be necessary for purposes of carrying out this section.
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Sec. 701
TRICARE Advantage demonstration program
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