§ 724. ENROLLMENT OF COVERED BENEFICIARIES.
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Fiscal Year 1997 Limitation .— During fiscal year 1997, the number of covered beneficiaries who are enrolled in managed care plans offered by designated providers may not exceed the number of such enrollees as of October 1, 1995 . The Secretary may waive the limitation under paragraph
(1)if the Secretary determines that additional enrollment authority for a designated provider is required to accommodate covered beneficiaries who are dependents of members of the uniformed services entitled to health care under section 1074(a) of title 10 , United States Code. Permanent Limitation .— For each fiscal year beginning after September 30, 1997 , the number of enrollees in managed care plans offered by designated providers may not exceed 110 percent of the number of such enrollees as of the first day of the immediately preceding fiscal year. The Secretary may waive this limitation as provided in subsection (a)(2). Retention of Current Enrollees .— An enrollee in the managed care plan of a designated provider as of September 30, 1997 , or such earlier date as the designated provider and the Secretary may agree upon, shall continue receiving services from the designated provider pursuant to the agreement entered into under section 722 unless the enrollee disenrolls from the designated provider. Except as provided in subsection (e), the administering Secretaries may not disenroll such an enrollee unless the disenrollment is agreed to by the Secretary and the designated provider. Additional Enrollment Authority .— Subject to paragraph (2), other covered beneficiaries may also receive health care services from a designated provider. The designated provider may market such services to, and enroll, covered beneficiaries who— do not have other primary health insurance coverage (other than Medicare coverage) covering basic primary care and inpatient and outpatient services; subject to the limitation in subparagraph (B), have other primary health insurance coverage (other than Medicare coverage) covering basic primary care and inpatient and outpatient services; or are enrolled in the direct care system under the TRICARE program, regardless of whether the covered beneficiaries were users of the health care delivery system of the uniformed services in prior years. For each fiscal year beginning after September 30, 2003 , the number of covered beneficiaries newly enrolled by designated providers pursuant to clause
(ii)of subparagraph
(A)during such fiscal year may not exceed 10 percent of the total number of the covered beneficiaries who are newly enrolled under such subparagraph during such fiscal year. For purposes of this subsection, a covered beneficiary who has other primary health insurance coverage includes any covered beneficiary who has primary health insurance coverage— on the date of enrollment with a designated provider pursuant to paragraph (2)(A)(i); or on such date of enrollment and during the period after such date while the beneficiary is enrolled with the designated provider. Special Rule for Medicare-Eligible Beneficiaries .— Except as provided in paragraph (2), if a covered beneficiary who desires to enroll in the managed care program of a designated provider is also entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act ( 42 U.S.C. 1395c et seq.), the covered beneficiary shall elect whether to receive health care services as an enrollee or under part A of title XVIII of the Social Security Act. The Secretary may disenroll an enrollee who subsequently violates the election made under this subsection and receives benefits under part A of title XVIII of the Social Security Act. After September 30, 2012 , a covered beneficiary (other than a beneficiary under section 1079 of title 10 , United States Code) who is also entitled to hospital insurance benefits under part A of title XVIII of the Social Security Act [ 42 U.S.C. 1395c et seq.] due to age may not enroll in the managed care program of a designated provider unless the beneficiary was enrolled in that program on September 30, 2012 . Information Regarding Eligible Covered Beneficiaries .— The Secretary shall provide, in a timely manner, a designated provider with an accurate list of covered beneficiaries within the marketing area of the designated provider to whom the designated provider may offer enrollment. Open Enrollment Demonstration Program .— The Secretary of Defense shall conduct a demonstration program under which covered beneficiaries shall be permitted to enroll at any time in a managed care plan offered by a designated provider consistent with the enrollment requirements for the TRICARE Prime option under the TRICARE program, but without regard to the limitation in subsection (b). The demonstration program under this subsection shall cover designated providers, selected by the Secretary of Defense, and the service areas of the designated providers. The demonstration program carried out under this section shall commence on October 1, 1999 , and end on September 30, 2001 . Not later than March 15, 2001 , the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on the demonstration program carried out under this subsection. The report shall include, at a minimum, an evaluation of the benefits of the open enrollment opportunity to covered beneficiaries and a recommendation on whether to authorize open enrollments in the managed care plans of designated providers permanently.
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§ 724
ENROLLMENT OF COVERED BENEFICIARIES.
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