§ 1095f. TRICARE program: referrals and preauthorizations under TRICARE Prime
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/usc/title-10/section-1095fA research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(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.
(A)The Secretary may waive the referral requirement in paragraph
(1)in such circumstances as the Secretary may establish for purposes of this subsection.
(B)The Secretary shall waive the referral requirement in paragraph
(1)in the case of a member of the armed forces serving on active duty who seeks to obtain any of the following kinds of care in a military medical treatment facility:
(i)Physical therapy.
(ii)Nutritional.
(iii)Audiological.
(iv)Optometric.
(v)Podiatric.
(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.
(4)Inpatient care at a residential treatment center.
(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.
(Added Pub. L. 106–398, § 1 [[div. A], title VII, § 728(a)(1)], Oct. 30, 2000, 114 Stat. 1654, 1654A–189; amended Pub. L. 114–328, div. A, title VII, § 701(c), Dec. 23, 2016, 130 Stat. 2186; Pub. L. 115–91, div. A, title VII, § 739(e)(1), Dec. 12, 2017, 131 Stat. 1447; Pub. L. 118–159, div. A, title VII, § 703, Dec. 23, 2024, 138 Stat. 1942.)
Connections17 cite this · traces to 8
Cited by 17 sections · top 14
public-private-law
U.S. Code
statutes-at-large
- Public Law 117–263To authorize appropriations for fiscal year 2023 for military activities of the Department of Defense, for military construction, and for defense activities of the Department of Energy, to prescribe military personnel strengths for such fiscal year, and for other purposes
- Public Law 115–232To authorize appropriations for fiscal year 2019 for military activities of the Department of Defense, for military construction, and for defense activities of the Department of Energy, to prescribe military personnel strengths for such fiscal year, and for other purposes
statute-compilations
bill
- Sec. 703Improvement of referrals for specialty care under TRICARE Prime during permanent changes of station
- Sec. 703Improvement of referrals for specialty care under TRICARE Prime during permanent changes of station
- Sec. 704Improvement of referrals for specialty care under TRICARE Prime during permanent changes of station
Traces to 8 documents
U.S. Code
public-private-law
- National Defense Authorization Act for Fiscal Year 2017Public Law 114-328
- National Defense Authorization Act for Fiscal Year 2018Public Law 115-91
- Servicemember Quality of Life Improvement and National Defense Authorization Act for Fiscal Year 2025Public Law 118-159
- John S. McCain National Defense Authorization Act for Fiscal Year 2019Public Law 115-232
- James M. Inhofe National Defense Authorization Act for Fiscal Year 2023Public Law 117-263
7 references not yet in our index
- Pub. L. 106–398, § 1 [[div. A]
- 114 Stat. 1654
- 130 Stat. 2186
- 131 Stat. 1447
- 138 Stat. 1942
- 132 Stat. 1812
- 136 Stat. 2647
Citation graph
cites case law
§ 1095f
TRICARE program: referrals and preauthorizations under TRICARE Prime
Fed. Reg.×4
Bills×3
U.S.C.×3
Pub. L.×2
Stat. Comp.×2
Stat.×2
C.F.R.×1
Pub. L.Pub. L. 106–398, § 1 [[div. A]
Stat.114 Stat. 1654
Stat.130 Stat. 2186
Stat.131 Stat. 1447
Cites 15 · showing 12Cited by 17 across 7 sources