Sec. 722. TRICARE AS SUPPLEMENT TO MEDICARE DEMONSTRATION

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## SEC. 722 TRICARE AS SUPPLEMENT TO MEDICARE DEMONSTRATION **[**[10 U.S.C. 1073 note](/us/usc/t10/s1073)**]** ###

(a)In General ####

(1)The Secretary of Defense shall, after consultation with the other administering Secretaries, carry out a demonstration project in order to assess the feasibility and advisability of providing medical care coverage under the TRICARE program to the individuals described in subsection (c). The demonstration project shall be known as the “TRICARE Senior Supplement”. ####

(2)The Secretary shall commence the demonstration project not later than January 1, 2000, and shall terminate the demonstration project not later than December 31, 2002. ####

(3)Under the demonstration project, the Secretary shall permit eligible individuals described in subsection

(c)to enroll in the TRICARE program. ####

(4)Payment for care and services received by eligible individuals who enroll in the TRICARE program under the demonstration project shall be made as follows: #####

(A)First, under title XVIII of the Social Security Act, but only to the extent that payment for such care and services is provided for under that title. #####

(B)Second, under the TRICARE program, but only to the extent that payment for such care and services is provided under that program and is not provided for under subparagraph (A). #####

(C)Third, by the eligible individual concerned, but only to the extent that payment for such care and services is not provided for under subparagraph

(A)or (B). ####

(5)#####

(A)The Secretary shall require each eligible individual who enrolls in the TRICARE program under the demonstration project to pay an enrollment fee. The Secretary shall provide, to the extent feasible, the option of payment of the enrollment fee through electronic transfers of funds and through withholding of such payment from the pay of a member or former member of the Armed Forces, and shall provide the option that payment of the enrollment fee be made in full at the beginning of the enrollment period or that payments be made on a monthly or quarterly basis. #####

(B)The amount of the enrollment fee charged an eligible individual under subparagraph

(A)for self-only or family enrollment in any year may not exceed the amount equal to 75 percent of the total subscription charges in that year for self-only or family, respectively, fee-for-service coverage under the health benefits plan under the Federal Employees Health Benefits program under chapter 89 of title 5, United States Code, that is most similar in coverage to the TRICARE program. ####

(6)A covered beneficiary who enrolls in TRICARE Senior Supplement under this subsection shall not be eligible to receive health care at a facility of the uniformed services during the period such enrollment is in effect. ###

(b)Evaluation; Review ####

(1)The Secretary shall provide for an evaluation of the demonstration project conducted under this subsection by an appropriate person or entity that is independent of the Department of Defense. The evaluation shall include the following: #####

(A)An analysis of the costs of the demonstration project to the United States and to the eligible individuals who participate in such demonstration project. #####

(B)An assessment of the extent to which the demonstration project satisfies the requirements of such eligible individuals for the health care services available under the demonstration project. #####

(C)An assessment of the effect, if any, of the demonstration project on military medical readiness. #####

(D)A description of the rate of the enrollment in the demonstration project of the individuals who were eligible to enroll in the demonstration project. #####

(E)An assessment of whether the demonstration project provides the most suitable model for a program to provide adequate health care services to the population of individuals consisting of the eligible individuals. #####

(F)An evaluation of any other matters that the Secretary considers appropriate. ####

(2)The Comptroller General shall review the evaluation conducted under paragraph (1). In carrying out the review, the Comptroller General shall— #####

(A)assess the validity of the processes used in the evaluation; and #####

(B)assess the validity of any findings under the evaluation, including any limitations with respect to the data contained in the evaluation as a result of the size and design of the demonstration project. ####

(3)#####

(A)The Secretary shall submit a report on the results of the evaluation under paragraph (1), together with the evaluation, to the Committee on Armed Services of the Senate and the Committee on Armed Services of the House of Representatives not later than December 31, 2002. #####

(B)The Comptroller General shall submit a report on the results of the review under paragraph

(2)to the committees referred to in subparagraph

(A)not later than February 15, 2003. ###

(c)Eligible Individuals An individual is eligible to participate under this section if the individual is a member or former member of the uniformed services described in section 1074(b) of title 10, United States Code, a dependent of the member described in section 1076(a)(2)(B) or 1076(b) of that title, or a dependent of a member of the uniformed services who died while on active duty for a period of more than 30 days, who— ####

(1)is 65 years of age or older; ####

(2)is entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act (42 U.S.C. 1395c et seq.); ####

(3)is enrolled in the supplemental medical insurance program under part B of such title XVIII (42 U.S.C. 1395j et seq.); and ####

(4)resides in an area selected by the Secretary under subsection (d). ###

(d)Areas of Implementation ####

(1)The Secretary shall carry out the demonstration project under this section in two separate areas selected by the Secretary. ####

(2)The areas selected by the Secretary under paragraph

(1)shall be as follows: #####

(A)One area shall be an area outside the catchment area of a military medical treatment facility in which— ######

(i)no eligible organization has a contract in effect under section 1876 of the Social Security Act (42 U.S.C. 1395mm) and no Medicare+Choice organization has a contract in effect under part C of title XVIII of that Act (42 U.S.C. 1395w–21); or ######

(ii)the aggregate number of enrollees with an eligible organization with a contract in effect under section 1876 of that Act or with a Medicare+Choice organization with a contract in effect under part C of title XVIII of that Act is less than 2.5 percent of the total number of individuals in the area who are entitled to hospital insurance benefits under part A of title XVIII of that Act. #####

(B)The other area shall be an area outside the catchment area of a military medical treatment facility in which— ######

(i)at least one eligible organization has a contract in effect under section 1876 of that Act or one Medicare+Choice organization has a contract in effect under part C of title XVIII of that Act; and ######

(ii)the aggregate number of enrollees with an eligible organization with a contract in effect under section 1876 of that Act or with a Medicare+Choice organization with a contract in effect under part C of title XVIII of that Act exceeds 10 percent of the total number of individuals in the area who are entitled to hospital insurance benefits under part A of title XVIII of that Act. ###

(e)Definitions In this section: ####

(1)The term “**administering Secretaries**” has the meaning given that term in section 1072(3) of title 10, United States Code. ####

(2)The term “**TRICARE program**” has the meaning given that term in section 1072(7) of title 10, United States Code.

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