Sec. 701. TRICARE SELECT AND OTHER TRICARE REFORM
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## SEC. 701 TRICARE SELECT AND OTHER TRICARE REFORM ###
(a)Establishment of TRICARE Select ####
(1)In general Chapter 55 of title 10, United States Code, is amended by inserting after section 1074n the following new section: > > ## “SEC. 1075 TRICARE Select > > **[**[10 U.S.C. 1075](/us/usc/t10/s1075)**]** > > > ### “(a) Establishment > > > ####
(1)> > 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 Select’. > > > #### “(2) > > The Secretary shall establish TRICARE Select in all areas. Under TRICARE Select, eligible beneficiaries will not have restrictions on the freedom of choice of the beneficiary with respect to health care providers. > > > ### “(b) Enrollment Eligibility > > > ####
(1)> > The beneficiary categories for purposes of eligibility to enroll in TRICARE Select and cost-sharing requirements applicable to such category are as follows: > > > ##### “(A) > > 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). > > > ##### “(B) > > 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. > > > ##### “(C) > > A ‘reserve and young adult’ category that consists of beneficiaries who are covered by— > > > ###### “(i) > > section 1076d of this title; > > > ###### “(ii) > > section 1076e; or > > > ###### “(iii) > > section 1110b. > > > #### “(2) > > A covered beneficiary who elects to participate in TRICARE Select shall enroll in such option under section 1099 of this title. > > > ### “(c) Cost-sharing Requirements > > The cost-sharing requirements under TRICARE Select are as follows: > > > #### “(1) > > 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). > > > #### “(2) > > > #####
(A)> > 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. > > > ##### “(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. > > > #### “(3) > > 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 section 1076d, 1076e, or 1110b of this title, as the case may be, shall apply instead of any enrollment fee required under this section. > > > ### “(d) Cost-sharing Amounts for Certain Beneficiaries > > > ####
(1)> > Beneficiaries described in subsection (c)(1) enrolled in TRICARE Select 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 Select** ** Active-Duty Family Member** (Individual/Family) ** Retired** (Individual/Family) **Annual Enrollment ** $0$450 / $900 **Annual deductible ** E4 & below: $50 / $100$150 / $300 Network E5 & above: $150 / $300$300 / $600 out of network **Annual catastrophic cap** $1,000$3,500 **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$80 network 20% out of network25% out of network **Urgent care civilian network** $20 network$40 network 20% out of network25% out of network **Ambulatory surgery civilian network** $25 network$95 network 20% out of network25% out of network **Ambulance civilian network** $15$60 **Durable medical equipment civilian network** 10% of negotiated fee20% network **Inpatient visit civilian network** $60 per network admission$175 per admission network 20% out of network25% out of network **Inpatient skilled nursing/rehab civilian** $25 per day network$50 per day network $50 per day out of networkLesser of $300 per day or 20% of billed charges out of network > > > #### “(2) > > Each dollar amount expressed as a fixed dollar amount in the table set forth in paragraph (1), and the amounts specified under paragraphs
(1)and
(2)of 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. > > > #### “(3) > > Enrollment fees, deductible amounts, and catastrophic caps under this section are on a calendar-year basis. > > > ### “(e) Exceptions to Certain Cost-sharing Amounts for Certain Beneficiaries Eligible Prior to 2018 > > > ####
(1)> > Subject to paragraph (4), 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 Select (other than such beneficiaries covered by paragraph (3)). Such enrollment fee shall be $150 for an individual and $300 for a family. > > > #### “(2) > > For the calendar year for which the Secretary first establishes the annual enrollment fee under paragraph (1), the Secretary shall adjust the catastrophic cap amount to be $3,500 for beneficiaries described in subsection (c)(2)(B) in the retired category who are enrolled in TRICARE Select (other than such beneficiaries covered by paragraph (3)). > > > #### “(3) > > The enrollment fee established pursuant to paragraph
(1)and the catastrophic cap adjusted under paragraph
(2)for beneficiaries described in subsection (c)(2)(B) in the retired category shall not apply with respect to the following beneficiaries: > > > ##### “(A) > > 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. > > > ##### “(B) > > Survivors covered by paragraph
(2)of such section 1086(c). > > > #### “(4) > > 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 (5). > > > #### “(5) > > 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: > > > ##### “(A) > > Whether health care coverage for covered beneficiaries has changed since the enactment of this section. > > > ##### “(B) > > Whether covered beneficiaries are able to obtain appointments for health care according to the access standards established by the Secretary of Defense. > > > ##### “(C) > > The percent of network providers that accept new patients under the TRICARE program. > > > ##### “(D) > > The satisfaction of beneficiaries under TRICARE Select. > > > ### “(f) Exception to Cost-sharing Requirements for TRICARE for Life Beneficiaries > > A beneficiary enrolled in TRICARE for Life is subject to cost-sharing requirements pursuant to section 1086(d)(3) of this title and calculated as if the beneficiary were enrolled in TRICARE Standard as if TRICARE Standard were still being carried out by the Secretary. > > > ### “(g) Construction > > Nothing in this section may be construed as affecting the availability of TRICARE Prime and TRICARE for Life or the cost-sharing requirements for TRICARE for Life under section 1086(d)(3) of this title. > > > ### “(h) Definitions > > In this section: > > > #### “(1) > > The terms ‘active-duty family member category’, ‘retired category’, and ‘reserve and young adult category’ mean the respective categories of TRICARE Select enrollment described in subsection (b). > > > #### “(2) > > The term ‘network’ means— > > > ##### “(A) > > with respect to health care services, such services provided to beneficiaries by TRICARE-authorized civilian health care providers who have entered into a contract under this chapter with a contractor under the TRICARE program; and > > > ##### “(B) > > with respect to providers, civilian health care providers who have agreed to accept a pre-negotiated rate as the total charge for services provided by the provider and to file claims for beneficiaries. > > > #### “(3) > > The term ‘out-of-network’ means, with respect to health care services, such services provided by TRICARE-authorized civilian providers who have not entered into a contract under this chapter with a contractor under the TRICARE program.” > . ####
(2)Clerical amendment **[**[10 U.S.C. 1071](/us/usc/t10/s1071)**]** 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 Select.” ". ###
(b)TRICARE Prime Cost Sharing ####
(1)In general Chapter 55 of title 10, United States Code, is amended by inserting after section 1075, as added by subsection (a), the following new section: > > ## “SEC. 1075a TRICARE Prime: cost sharing > > **[**[10 U.S.C. 1075a](/us/usc/t10/s1075a)**]** > > > ### “(a) Cost-sharing Requirements > > The cost-sharing requirements under TRICARE Prime are as follows: > > > #### “(1) > > There are no cost-sharing requirements for beneficiaries who are covered by section 1074(a) of this title. > > > #### “(2) > > 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). > > > #### “(3) > > > #####
(A)> > 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). > > > ##### “(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. > > > ### “(b) Cost-sharing Amounts > > > ####
(1)> > 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)Annual Enrollment$0$350 / $700Annual deductibleNoNoAnnual catastrophic cap$1,000$3,500Outpatient visit civilian network$0$20 primary care $30 specialty careER visit civilian network$0$60 networkUrgent care civilian network$0$30 networkAmbulatory surgery civilian network$0$60 networkAmbulance civilian network$0$40Durable medical equipment civilian network$020% of negotiated fee, networkInpatient visit civilian network$0$150 per admissionInpatient skilled nursing/rehab civilian$0$30 per day network > > > #### “(2) > > 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. > > > #### “(3) > > Enrollment fees, deductible amounts, and catastrophic caps under this section are on a calendar-year basis. > > > ### “(c) Special Rule for Amounts Without Referrals > > Notwithstanding subsection (b)(1), the cost-sharing amount for a beneficiary enrolled in TRICARE Prime who does not obtain a referral for care under paragraph
(1)of section 1075f(a) of this title (or a waiver pursuant to paragraph
(2)of such section for such care) shall be an amount equal to 50 percent of the allowed point-of-service charge for such care.” > . ####
(2)Clerical amendment **[**[10 U.S.C. 1071](/us/usc/t10/s1071)**]** 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.” ". ###
(c)Referrals and Preauthorization for TRICARE Prime Section 1095f of title 10, United States Code, is amended to read as follows: > > ## “SEC. 1095f TRICARE program: referrals and preauthorizations under TRICARE Prime > > > ### “(a) Referrals > > > ####
(1)> > Except as provided by paragraph (2), a beneficiary enrolled in TRICARE Prime shall be required to obtain a referral for care through a designated primary care manager (or other care coordinator) prior to obtaining care under the TRICARE program. > > > #### “(2) > > The Secretary may waive the referral requirement in paragraph
(1)in such circumstances as the Secretary may establish for purposes of this subsection. > > > #### “(3) > > The cost-sharing amounts for a beneficiary enrolled in TRICARE Prime who does not obtain a referral for care under paragraph
(1)(or a waiver pursuant to paragraph
(2)for such care) shall be determined under section 1075a(c) of this title. > > > ### “(b) Preauthorization > > A beneficiary enrolled in TRICARE Prime shall be required to obtain preauthorization only with respect to a referral for the following: > > > #### “(1) > > Inpatient hospitalization. > > > #### “(2) > > Inpatient care at a skilled nursing facility. > > > #### “(3) > > Inpatient care at a rehabilitation facility. > > > ### “(c) Prohibition Regarding Prior Authorization for Certain Referrals > > The Secretary of Defense shall ensure that no contract for managed care support under the TRICARE program includes any requirement that a managed care support contractor require a primary care or specialty care provider to obtain prior authorization before referring a patient to a specialty care provider that is part of the network of health care providers or institutions of the contractor.” > . ###
(d)Enrollment Periods ####
(1)Annual periods and qualifying events Section 1099(b) of title 10, United States Code, is amended by amending paragraph
(1)to read as follows: > > #### “(1) > > allow covered beneficiaries to elect to enroll in a health care plan, or modify a previous election, from eligible health care plans designated by the Secretary of Defense during— > > > ##### “(A) > > an annual open enrollment period; and > > > ##### “(B) > > any period based on a qualifying event experienced by the beneficiary, as determined appropriate by the Secretary; or” > . ####
(2)Application **[**[10 U.S.C. 1099 note](/us/usc/t10/s1099)**]** The Secretary of Defense shall implement the initial annual open enrollment period pursuant to section 1099(b)(1) of title 10, United States Code, as amended by paragraph (1), during 2018. ####
(3)Grace period during first year **[**[10 U.S.C. 1099 note](/us/usc/t10/s1099)**]** #####
(A)At any time during the one-year period beginning on the date on which the initial annual open enrollment period begins pursuant to section 1099(b)(1) of title 10, United States Code, as amended by paragraph (1), a covered beneficiary may make an election, or modify such an election, described in such section. #####
(B)If during such one-year period an individual who is eligible to enroll in the TRICARE program, but does not elect to enroll in such program, receives health care services for an episode of care that would be covered under the TRICARE program if such individual were enrolled in the TRICARE program, the Secretary— ######
(i)shall pay the out-of-network fees only for the first episode of care and inform the individual of the opportunity to enroll in the TRICARE program; and ######
(ii)may not pay any costs relating to any subsequent episode of care if such individual is not enrolled in the TRICARE program. ####
(4)Transition plan Not later than March 1, 2017, the Secretary shall provide to the Committees on Armed Services of the Senate and the House of Representatives a briefing on the transition plan of the Department of Defense for implementing an annual enrollment period for TRICARE Prime and TRICARE Select pursuant to section 1099(b)(1) of title 10, United States Code, as amended by paragraph (1). Such plan shall include strategies to notify each beneficiary of the changes to the TRICARE options and the changes to the enrollment process. ###
(e)Termination of TRICARE Standard and TRICARE Extra **[**[10 U.S.C. 1073 note](/us/usc/t10/s1073)**]** 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 or TRICARE Select, as the case may be, as of January 1, 2018, for the individual to continue coverage under the TRICARE program. ###
(f)Implementation Plan ####
(1)In general 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. ####
(2)Elements The plan under paragraph
(1)shall— #####
(A)ensure that at least 85 percent of the beneficiary population under TRICARE Select is covered by the network by January 1, 2018; #####
(B)ensure access standards for appointments for health care that meet or exceed those of high-performing health care systems in the United States, as determined by the Secretary; #####
(C)establish mechanisms for monitoring compliance with access standards; #####
(D)establish health care provider-to-beneficiary ratios; #####
(E)monitor on a monthly basis complaints by beneficiaries with respect to network adequacy and the availability of health care providers; #####
(F)establish requirements for mechanisms to monitor the responses to complaints by beneficiaries; #####
(G)establish mechanisms to evaluate the quality metrics of the network providers established under section 728; #####
(H)include any recommendations for legislative action the Secretary determines necessary to carry out the plan; and #####
(I)include any other elements the Secretary determines appropriate. ###
(g)GAO Reviews ####
(1)Implementation plan 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 (f), including an assessment of the adequacy of the plan in meeting the elements specified in paragraph
(2)of such subsection. ####
(2)Network 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: #####
(A)An identification of the percent of beneficiaries who are covered by the network. #####
(B)An assessment of the extent to which beneficiaries are able to obtain appointments under TRICARE Extra. #####
(C)The percent of network providers under TRICARE Extra that accept new patients under the TRICARE program. #####
(D)An assessment of the satisfaction of beneficiaries under TRICARE Extra. ###
(h)Pilot Program on Incorporation of Value-based Health Care in Purchased Care Component of TRICARE Program **[**[10 U.S.C. 1073 note](/us/usc/t10/s1073)**]** ####
(1)In general Not later than January 1, 2018, the Secretary of Defense shall carry out a pilot program to demonstrate and assess the feasibility of incorporating value-based health care methodology in the purchased care component of the TRICARE program by reducing copayments or cost shares for targeted populations of covered beneficiaries in the receipt of high-value medications and services and the use of high-value providers under such purchased care component, including by exempting certain services from deductible requirements. ####
(2)Requirements In carrying out the pilot program under paragraph (1), the Secretary shall— #####
(A)identify each high-value medication and service that is covered under the purchased care component of the TRICARE program for which a reduction or elimination of the copayment or cost share for such medication or service would encourage covered beneficiaries to use the medication or service; #####
(B)reduce or eliminate copayments or cost shares for covered beneficiaries to receive high-value medications and services; #####
(C)reduce or eliminate copayments or cost shares for covered beneficiaries to receive health care services from high-value providers; #####
(D)credit the amount of any reduction or elimination of a copayment or cost share under subparagraph
(B)or
(C)for a covered beneficiary towards meeting a deductible applicable to the covered beneficiary in the purchased care component of the TRICARE program to the same extent as if such reduction or elimination had not applied; and #####
(E)develop a process to reimburse high-value providers at rates higher than those rates for health care providers that are not high-value providers. ####
(3)Report on value-based health care methodology Not later than 180 days 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 that includes the following: #####
(A)A list of each high-value medication and service identified under paragraph (2)(A) for which the copayment or cost share amount will be reduced or eliminated under the pilot program to encourage covered beneficiaries to use such medications and services through the purchased care component of the TRICARE program. #####
(B)For each high-value medication and service identified under paragraph (2)(A), the amount of the copayment or cost share required under the purchased care component of the TRICARE program and the amount of any reduction or elimination of such copayment or cost share pursuant to the pilot program. #####
(C)A description of a plan to identify and communicate to covered beneficiaries, through multiple communication media— ######
(i)the list of high-value medications and services described in subparagraph (A); and ######
(ii)a list of high-value providers. #####
(D)A description of modifications, if any, to existing health care contracts that may be required to implement value-based health care methodology in the purchased care component of the TRICARE program under the pilot program and the estimated costs of those contract modifications. ####
(4)Comptroller general preliminary review and assessment #####
(A)Not later than March 1, 2021, the Comptroller General of the United States shall submit to the Committees on Armed Services of the Senate and the House of Representatives a review and assessment of the preliminary results of the pilot program. #####
(B)The review and assessment required under subparagraph
(A)shall include the following: ######
(i)An assessment of the extent of the use of value-based health care methodology in the purchased care component of the TRICARE program under the pilot program. ######
(ii)An analysis demonstrating how reducing or eliminating the copayment or cost share for each high-value medication and service identified under paragraph (2)(A) resulted in— ######
(I)increased adherence to medication regimens; ######
(II)improvement of quality measures; ######
(III)improvement of health outcomes; ######
(IV)reduction of number of emergency room visits or hospitalizations; and ######
(V)enhancement of experience of care for covered beneficiaries. ######
(iii)Such recommendations for incentivizing the use of high-value medications and services to improve health outcomes and the experience of care for beneficiaries as the Comptroller General considers appropriate. ####
(5)Review and assessment of pilot program #####
(A)Not later than January 1, 2023, the Secretary shall submit to the Committees on Armed Services of the Senate and the House of Representatives a review and assessment of the pilot program. #####
(B)The review and assessment required under subparagraph
(A)shall include the following: ######
(i)An assessment of the extent of the use of value-based health care methodology in the purchased care component of the TRICARE program under the pilot program. ######
(ii)An analysis demonstrating how reducing or eliminating the copayment or cost share for each high-value medication and service identified under paragraph (2)(A) resulted in— ######
(I)increased adherence to medication regimens; ######
(II)improvement of quality measures; ######
(III)improvement of health outcomes; and ######
(IV)enhancement of experience of care for covered beneficiaries. ######
(iii)A cost-benefit analysis of the implementation of value-based health care methodology in the purchased care component of the TRICARE program under the pilot program. ######
(iv)Such recommendations for incentivizing the use of high-value medications and services to improve health outcomes and the experience of care for covered beneficiaries as the Secretary considers appropriate. ####
(6)Termination The Secretary may not carry out the pilot program after December 31, 2022. ###
(i)Definitions **[**[10 U.S.C. 1073 note](/us/usc/t10/s1073)**]** In this section: ####
(1)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 (j). ####
(2)The term “TRICARE Select” means the self-managed, preferred-provider network option under the TRICARE program established by section 1075 of such title, as added by subsection (a). ####
(3)The term “chronic conditions” includes diabetes, chronic obstructive pulmonary disease, asthma, congestive heart failure, hypertension, history of stroke, coronary artery disease, mood disorders, and such other diseases or conditions as the Secretary considers appropriate. ####
(4)The term “high-value medications and services” means prescription medications and clinical services for the management of chronic conditions that the Secretary determines would improve health outcomes and create health value for covered beneficiaries (such as preventive care, primary and specialty care, diagnostic tests, procedures, and durable medical equipment). ####
(5)The term “high-value provider” means an individual or institutional health care provider that provides health care under the purchased care component of the TRICARE program and that consistently improves the experience of care, meets established quality of care and effectiveness metrics, and reduces the per capita costs of health care. ####
(6)The term “value-based health care methodology” means a methodology for identifying specific prescription medications and clinical services provided under the TRICARE program for which reduction of copayments, cost shares, or both, would improve the management of specific chronic conditions because of the high value and clinical effectiveness of such medications and services for such chronic conditions. ###
(j)Conforming Amendments ####
(1)In general Title 10, United States Code, is amended as follows: #####
(A)Section 1072 is amended— ######
(i)by striking paragraph
(7)and inserting the following: > > #### “(7) > > 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: > > > ##### “(A) > > TRICARE Prime. > > > ##### “(B) > > TRICARE Select. > > > ##### “(C) > > TRICARE for Life.” > ; and ######
(ii)by adding at the end the following new paragraphs: > > #### “(11) > > 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. > > > #### “(12) > > The term ‘TRICARE Select’ means the self-managed, preferred-provider network option under the TRICARE program established by section 1075 of this title. > > > #### “(13) > > 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. > > > #### “(14) > > The term ‘TRICARE Prime’ means the managed care option of the TRICARE program. > > > #### “(15) > > The term ‘TRICARE Standard’ means the TRICARE program made available prior to January 1, 2018, covering— > > > ##### “(A) > > medical care to which a dependent described in section 1076(a)(2) of this title is entitled; and > > > ##### “(B) > > 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.” > . #####
(B)Section 1076d is amended— ######
(i)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 ######
(ii)in subsection (f), by striking paragraph
(2)and inserting the following new paragraph: > > #### “(2) > > The term ‘TRICARE Reserve Select’ means the TRICARE Select 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 ######
(iii)by striking “TRICARE Standard” each place it appears (including in the heading of such section) and inserting “TRICARE Reserve Select”. #####
(C)Section 1076e is amended— ######
(i)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 ######
(ii)in subsection (f), by striking paragraph
(2)and inserting the following new paragraph: > > #### “(2) > > The term ‘TRICARE Retired Reserve’ means the TRICARE Select 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).” > ; ######
(iii)in subsection (b), by striking “TRICARE Standard coverage at” and inserting “TRICARE coverage at”; and ######
(iv)by striking “TRICARE Standard” each place it appears (including in the heading of such section) and inserting “TRICARE Retired Reserve”. #####
(D)Section 1079a is amended— ######
(i)in the section heading, by striking “CHAMPUS” and inserting “TRICARE program”; and ######
(ii)by striking “the Civilian Health and Medical Program of the Uniformed Services” and inserting “the TRICARE program”. #####
(E)Section 1099(c) is amended by striking paragraph
(2)and inserting the following new paragraph: > > #### “(2) > > A plan under the TRICARE program.” > . #####
(F)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.”. ####
(2)Clerical amendments **[**[10 U.S.C. 1071](/us/usc/t10/s1071)**]** The table of sections at the beginning of chapter 55 of title 10, United States Code, is further amended— #####
(A)in the item relating to section 1076d, by striking “TRICARE Standard” and inserting “TRICARE Reserve Select”; #####
(B)in the item relating to section 1076e, by striking “TRICARE Standard” and inserting “TRICARE Retired Reserve”; #####
(C)in the item relating to section 1079a, by striking “CHAMPUS” and inserting “TRICARE program”; and #####
(D)in the item relating to section 1095f, by striking “for specialty health care” and inserting “and preauthorizations under TRICARE Prime”. ####
(3)Conforming style 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. ###
(k)Application **[**[10 U.S.C. 1072 note](/us/usc/t10/s1072)**]** 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.
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Sec. 701
TRICARE SELECT AND OTHER TRICARE REFORM
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