[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1456 Introduced in House (IH)]







105th CONGRESS
  1st Session
                                H. R. 1456

    To amend title 10, United States Code, to improve the access to 
  military treatment facilities for retired members of the uniformed 
   services, and their dependents, who are over 65 years of age, to 
provide for Medicare reimbursement for health care services provided to 
 such persons, and, as an alternative health care approach, to permit 
    such persons to enroll in the Federal Employees Health Benefits 
                                program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 24, 1997

Mr. Thornberry introduced the following bill; which was referred to the 
   Committee on Ways and Means, and in addition to the Committees on 
Commerce, National Security, and Government Reform and Oversight, for a 
 period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
                          committee concerned

_______________________________________________________________________

                                 A BILL


 
    To amend title 10, United States Code, to improve the access to 
  military treatment facilities for retired members of the uniformed 
   services, and their dependents, who are over 65 years of age, to 
provide for Medicare reimbursement for health care services provided to 
 such persons, and, as an alternative health care approach, to permit 
    such persons to enroll in the Federal Employees Health Benefits 
                                program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Uniformed Services 
Retiree and Dependents Health Care Availability Act''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
     TITLE I--ENROLLMENT OF RETIREES IN TRICARE PRIME AND Medicare 
                             REIMBURSEMENT

Sec. 101. Definitions.
Sec. 102. Availability of TRICARE-prime for Medicare-eligible uniformed 
                            services retirees.
Sec. 103. Medicare reimbursement.
Sec. 104. Determination of reimbursement amounts.
Sec. 105. Maintenance of defense health care effort.
Sec. 106. Department of Defense payment of late enrollment penalty 
                            under Medicare.
Sec. 107. Medigap special open enrollment period for certain uniformed 
                            services retirees and dependents.
                  TITLE II--FEHBP OPTION FOR RETIREES

Sec. 201. Inclusion of Medicare-eligible uniformed services retirees in 
                            Federal Employees Health Benefits program.
Sec. 202. Improved benefits under CHAMPUS and TRICARE standard.

     TITLE I--ENROLLMENT OF RETIREES IN TRICARE PRIME AND Medicare 
                             REIMBURSEMENT

SEC. 101. DEFINITIONS.

    For purposes of this title:
            (1) Medicare-eligible uniformed services retiree.--The term 
        ``Medicare-eligible uniformed services retiree'' means a member 
        or former member of a uniformed service who is entitled to 
        retired pay or retainer pay (or equivalent pay), or a dependent 
        covered by section 1076(b) of title 10, United States Code, who 
        is entitled to hospital insurance benefits under part A of 
        title XVIII of the Social Security Act (42 U.S.C. 1395c et 
        seq.).
            (2) TRICARE program.--The term ``TRICARE program'' means 
        the managed health care program that is established by the 
        Secretary of Defense under the authority of chapter 55 of title 
        10, United States Code, principally section 1097 of such title, 
        and includes the competitive selection of contractors to 
        financially underwrite the delivery of health care services 
        under the Civilian Health and Medical Program of the Uniformed 
        Services.
            (3) Subvention program.--The term ``subvention program'' 
        means the program established under section 103 to reimburse 
        the Department of Defense, from the Medicare program under 
        title XVIII of the Social Security Act (42 U.S.C. 1395 et 
        seq.), for health care services provided to Medicare-eligible 
        uniformed services retirees through the TRICARE program.
            (4) Dependent.--The term ``dependent'' has the meaning 
        given the term in section 1072(2) of title 10, United States 
        Code.
            (5) Secretaries.--The term ``Secretaries'' means the 
        Secretary of Defense and the Secretary of Health and Human 
        Services acting jointly.

SEC. 102. AVAILABILITY OF TRICARE-PRIME FOR MEDICARE-ELIGIBLE UNIFORMED 
              SERVICES RETIREES.

    The Secretary of Defense may not prohibit the enrollment of 
Medicare-eligible uniformed services retirees in the managed care 
option of the TRICARE program (known as TRICARE prime) solely on 
account of age or the entitlement of such persons to hospital insurance 
benefits under part A of title XVIII of the Social Security Act (42 
U.S.C. 1395c et seq.).

SEC. 103. MEDICARE REIMBURSEMENT.

    (a) Reimbursement Required.--To increase the number of Medicare-
eligible uniformed services retirees able to enroll in the managed care 
option of the TRICARE program, the Secretary of Defense and the 
Secretary of Health and Human Services shall jointly establish a 
program to provide the department of Defense with reimbursement, 
beginning October 1, 1997, from the Medicare program under title XVIII 
of the Social Security Act (42 U.S.C. 1395 et seq.) for health care 
services provided to Medicare-eligible uniformed services retirees 
through the TRICARE program. Reimbursement will only be provided in the 
case of Medicare-eligible uniformed services retirees who are also 
enrolled in the supplementary medical insurance program under part B of 
title XVIII of the Social Security Act (42 U.S.C. 1395j et seq.).
    (b) Voluntary Enrollment.--For purposes of the subvention program, 
enrollment of Medicare-eligible uniformed services retirees in an 
option of the TRICARE program shall be voluntary, except that the total 
number of Medicare-eligible uniformed services retirees so enrolled 
shall be subject to the capacity and funding limitations specified in 
sections 104 and 105.
    (c) Effect of Enrollment.--In the case of a Medicare-eligible 
uniformed services retiree who enrolls in an option of the TRICARE 
program, payments may not be made under title XVIII of the Social 
Security Act (42 U.S.C. 1395 et seq.) other than under the subvention 
program for health care services provided through the TRICARE program, 
except that the Secretaries may provide exceptions for emergencies or 
other situations as the Secretaries consider appropriate.
    (d) TRICARE Program Enrollment Fee Waiver.--The Secretary of 
Defense shall waive the enrollment fee applicable to any Medicare-
eligible uniformed services retiree enrolled in the managed care option 
of the TRICARE program for whom reimbursement may be made under section 
104.
    (e) Modification of TRICARE Contracts.--In carrying out the 
subvention program, the Secretary of Defense may amend existing TRICARE 
program contracts as may be necessary to incorporate provisions 
specifically applicable to Medicare-eligible uniformed services 
retirees who enroll in an option of the TRICARE program.
    (f) Cost Sharing.--The Secretary of Defense may establish cost 
sharing requirements for Medicare-eligible uniformed services retirees 
who enroll in an option of the TRICARE program and for whom 
reimbursement may be made under section 104.

SEC. 104. DETERMINATION OF REIMBURSEMENT AMOUNTS.

    (a) Reimbursement of Department of Defense.--Beginning October 1, 
1997, monthly payments to the Department of Defense under the 
subvention program shall be made from the Medicare program under title 
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) on the basis 
that payments are made under section 1876(a) of the Act (42 U.S.C. 
1395mm(a)).
    (b) Amount of Payments.--The Secretary of Health and Human Services 
shall make payments to the Department of Defense from the Federal 
Hospital Insurance Trust Fund and the Federal Supplementary 
Medical Insurance Trust Fund (allocated by the Secretary of Health and 
Human Services between each trust fund based on the relative weight 
that each trust fund contributes to the required payment) at a per 
capita rate equal to 93 percent of the applicable adjusted average per 
capita cost for each Medicare-eligible uniformed services retiree 
enrolled in the TRICARE program in excess of the number of such 
uniformed services retirees calculated under section 105 for the 
Department of Defense maintenance of health care effort.

SEC. 105. MAINTENANCE OF DEFENSE HEALTH CARE EFFORT.

    (a) Maintenance of Effort Required.--The Secretary of Defense shall 
maintain the Department of Defense health care efforts for Medicare-
eligible uniformed services retirees so as to avoid imposing on the 
Medicare program those costs that the Department of Defense would be 
expected to incur to provide health care services to Medicare-eligible 
uniformed services retirees in the absence of the subvention program.
    (b) Estimate of Prior Effort.--For the first fiscal year of the 
subvention program, the Secretaries shall estimate the amount expended 
by the Department of Defense for fiscal year 1997 for providing health 
care items and services (other than pharmaceuticals provided to 
outpatients) to Medicare-eligible uniformed services retirees. For 
subsequent fiscal years, the amount so estimated shall be adjusted for 
inflation, for differences between estimated and actual amounts 
expended, and for major changes in the Department of Defense health 
care budget.
    (c) Target for Defense Effort.--On the basis of the estimate made 
under subsection (b), the Secretaries shall establish monthly targets 
of the number of Medicare-eligible uniformed services retirees for whom 
reimbursement will not be provided to the Department of Defense under 
section 104.
    (d) Protection of Medicare Program Against Increased Costs.--
            (1) Purpose.--The purpose of this subsection is to protect 
        the Medicare program against costs incurred under section 104 
        in connection with the provision of health care services to 
        Medicare-eligible uniformed services retirees that would not 
        have been incurred by the Medicare program in the absence of 
        the reimbursement requirement.
            (2) Review by comptroller general.--Not later than December 
        31 of each year, the Comptroller General shall determine and 
        submit to the Secretaries and Congress a report on the extent, 
        if any, to which the costs of the Secretary of Defense under 
        the TRICARE program and the costs of the Secretary of Health 
        and Human Services under the Medicare program have increased as 
        a result of the subvention program.
            (3) Actions to prevent increased costs.--If the Secretaries 
        determine that the trust funds under title XVIII of the Social 
        Security Act (42 U.S.C. 1395 et seq.) still incur excess costs 
        as a result of the subvention program, the Secretaries shall 
        take such steps as may be necessary to offset those excess 
        costs (and prevent future excess costs), including suspension 
        or termination of the subvention program, adjustment of the 
        payment rate under section 104(b), or an adjustment of the 
        maintenance of effort requirements of the Department of Defense 
        under this section.

SEC. 106. DEPARTMENT OF DEFENSE PAYMENT OF LATE ENROLLMENT PENALTY 
              UNDER MEDICARE.

    (a) Department of Defense Payment.--In the case of any Medicare-
eligible uniformed services retiree who enrolls under part B of title 
XVIII of the Social Security Act and who, because of the date of such 
enrollment, is subject to the late enrollment penalty imposed pursuant 
to section 1839(b) of the Social Security Act on the monthly premium 
under part B of such title, the Secretary of Defense shall reimburse 
the Medicare-eligible uniformed services retiree for the cost of such 
penalty by--
            (1) increasing the amount of a payment otherwise made by 
        the Department of Defense to the Medicare-eligible uniformed 
        services retiree, such as retired or retainer pay; or
            (2) making a special payment to the Medicare-eligible 
        uniformed services retiree to cover the cost of such penalty.
    (b) Eligible Medicare-Eligible Uniformed Services Retiree 
Described.--A Medicare-eligible uniformed services retiree referred to 
in this section is a Medicare-eligible uniformed services retiree--
            (1) who is at least 65 years of age and was eligible to 
        enroll under part B of title XVIII of the Social Security Act, 
        and
            (2) who at the time the individual first satisfied 
        paragraph (1) or (2) of section 1836 of the Social Security 
        Act, did not elect to enroll (or to be deemed enrolled) under 
        section 1837 of the Social Security Act during the individual's 
        initial enrollment period.

SEC. 107. MEDIGAP SPECIAL OPEN ENROLLMENT PERIOD FOR CERTAIN UNIFORMED 
              SERVICES RETIREES AND DEPENDENTS.

    (a) Medigap Special Open Enrollment Period.--Notwithstanding any 
other provision of law, in the case of a Medicare-eligible uniformed 
services retiree who seeks to enroll in a Medicare supplemental policy 
(as defined in section 1882(g) of the Social Security Act), the issuer 
of the Medicare supplemental policy--
            (1) may not deny or condition the issuance or effectiveness 
        of a Medicare supplemental policy; and
            (2) may not discriminate in the pricing of the policy on 
        the basis of the individual's health status, medical condition 
        (including both physical and mental illnesses), claims 
        experience, receipt of health care, medical history, genetic 
        information, evidence of insurability (including conditions 
        arising out of acts of domestic violence), or disability.
    (b) Eligible Medicare-Eligible Uniformed Services Retiree 
Described.--A Medicare-eligible uniformed services retiree referred to 
in this section is a Medicare-eligible uniformed services retiree--
            (1) who is at least 65 years of age and was eligible to 
        enroll under part B of title XVIII of the Social Security Act, 
        and
            (2) who at the time the individual first satisfied 
        paragraph (1) or (2) of section 1836 of the Social Security 
        Act, did not elect to enroll (or to be deemed enrolled) under 
        section 1837 of the Social Security Act during the individual's 
        initial enrollment period.

                  TITLE II--FEHBP OPTION FOR RETIREES

SEC. 201. INCLUSION OF MEDICARE-ELIGIBLE UNIFORMED SERVICES RETIREES IN 
              FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM.

    (a) FEHBP Option.--Chapter 55 of title 10, United States Code, is 
amended by adding at the end the following new section:
``Sec. 1107. Health care coverage through Federal Employees Health 
              Benefits Program
    ``(a) FEHBP Option.--The Secretary of Defense, after consulting 
with the other administering Secretaries, shall enter into an agreement 
with the Office of Personnel Management under which a Medicare-eligible 
uniformed services retiree will be offered an opportunity to enroll in 
a health benefits plan offered through the Federal Employee Health 
Benefits program, as an additional option for receiving health care 
services under this chapter. The agreement may provide for limitations 
on enrollment of Medicare-eligible uniformed services retirees in the 
Federal Employee Health Benefits program if the Office of Personnel 
Management determines the limitations are necessary to allow for 
adequate planning for access for services under the Federal Employee 
Health Benefits program.
    ``(b) Medicare-Eligible Uniformed Services Retiree Defined.--In 
this section, the term `Medicare eligible uniformed services retiree' 
means a member or former member of a uniformed service who is entitled 
to retired pay or retainer pay (or equivalent pay), or a dependent 
covered by section 1076(b) of this title, who is entitled to hospital 
insurance benefits under part A of title XVIII of the Social Security 
Act (42 U.S.C. 1395c et seq.).
    ``(c) Continued Participation in Uniformed Services Health 
System.--A Medicare-eligible uniformed services retiree who enrolls in 
a health benefits plan offered through the Federal Employee Health 
Benefits program pursuant to subsection (a) may continue, after such 
enrollment, to receive health care services through a treatment 
facility of the uniformed services. Section 1095 of this title, 
relating to collection from third-party payers, shall apply with 
respect to the costs of health care services incurred by the United 
States on behalf of an enrolled uniformed services retiree through a 
treatment facility of the uniformed services, the Civilian Health and 
Medical Program of the Uniformed Services, or the TRICARE program.
    ``(d) Contributions.--(1) In the case of a Medicare-eligible 
uniformed services retiree who enrolls in a health benefits plan 
offered through the Federal Employee Health Benefits program pursuant 
to subsection (a), the administering Secretary concerned shall be 
responsible for Government contributions that the Office of Personnel 
Management determines are necessary to cover all costs in excess of 
contributions under paragraph (2).
    ``(2) The contribution required from the enrolled uniformed 
services retiree shall be equal to the amount that would be withheld 
from the pay of a similarly situated Federal employee who enrolls in a 
health benefits plan under chapter 89 of title 5.
    ``(e) Management of Participation.--If the enrolled uniformed 
services retiree is a member or former member of the uniformed services 
described in section 1074(b) of this title, the authority responsible 
for approving retired or retainer pay or equivalent pay for the member 
or former member shall manage he participation of the enrolled member 
or former member in a health benefits plan offered through the Federal 
Employee Health Benefits program pursuant to subsection (a). If the 
enrolled uniformed services retiree is a dependent of a member or 
former member, the authority that is, or would be, responsible for 
approving retired or retainer pay or equivalent pay for the member or 
former member shall manage the participation of the enrolled dependent 
in a health benefits plan offered through the Federal Employee Health 
Benefits program under subsection (a). The Office of Personnel 
Management shall maintain separate risk pools for enrolled uniformed 
services retirees until such time as the Director of the Office of 
Personnel Management determines that complete inclusion of enrolled 
uniformed services retirees under chapter 89 of title 5 will not 
adversely affect Federal employees and annuitants enrolled in health 
benefits plans under such chapter.
    ``(f) Effect of Cancellation.--The cancellation by a Medicare-
eligible uniformed services retiree of coverage under the Federal 
Employee Health Benefits program shall be irrevocable except as 
provided by the administering Secretaries.
    ``(g) Reporting Requirements.--Not later than November 1 of each 
year, the administering Secretaries and the Director of the Office of 
Personnel Management shall jointly submit a report to Congress 
describing the provision of health care services to Medicare-eligible 
uniformed services retirees under this section during the preceding 
fiscal year. The report shall address or contain the following:
            ``(1) The number of Medicare-eligible uniformed services 
        retirees enrolled in health benefits plans offered through the 
        Federal Employee Health Benefits program pursuant to subsection 
        (a), both in terms of total number and as a percentage of all 
        Medicare-eligible uniformed services retirees receiving health 
        care through the health care system of the uniformed services.
            ``(2) The out-of-pocket cost to enrolled uniformed services 
        retirees under such health benefits plans.
            ``(3) The cost to the Government (including the Department 
        of Defense, the Department of Commerce, the Department of 
        Transportation, and the Department of Health and Human 
        Services) of providing care under such health benefits plans as 
        a result of this section.
            ``(4) A comparison of the costs determined under paragraphs 
        (2) and (3) and the costs that would have otherwise been 
        incurred by the Government and enrolled uniformed services 
        retirees under alternative health care options available to the 
        administering Secretaries.
            ``(5) The effect of this section on the cost, access, and 
        utilization rates of other health care options under the health 
        care system of the uniformed services.
    ``(h) Time for Option.--The Secretary of Defense shall begin to 
offer the health benefits option under subsection (a) not later than 
January 1, 1999.''.
    ``(b) Clerical Amendment.--The table of sections at the beginning 
of such chapter is amended by adding at the end the following new item:

``1107. Health care coverage through Federal Employees Health Benefits 
                            program.''.

SEC. 202. IMPROVED BENEFITS UNDER CHAMPUS AND TRICARE STANDARD.

    (a) Comparability.--(1) Chapter 55 of title 10, United States Code, 
is further amended by inserting after section 1107 (as added by section 
201) the following new section:
``Sec. 1108. CHAMPUS and TRICARE Standard benefits: comparability with 
              service benefit plan of the Federal Employees Health 
              Benefits program
    ``(a) Benefits.--The health and dental care benefits provided under 
CHAMPUS and TRICARE Standard shall be comparable to the highest level 
of benefits provided under the service benefit plan of the Federal 
Employees Health Benefits program.
    ``(b) Provider Reimbursement Rates.--The rates prescribed for the 
reimbursement of health and dental care providers under CHAMPUS and 
TRICARE Standard shall be the same as those provided for the highest 
level of benefits under the service benefit plan of the Federal 
Employees Health Benefits program.
    ``(c) Effect of Failure To Comply.--If the Secretary of Defense 
certifies to Congress that the Secretary is unable to satisfy the 
requirements of subsections (a) and (b), section 1107 of this title 
shall apply to covered beneficiaries participating in CHAMPUS and 
TRICARE Standard so as to permit such covered beneficiaries to enroll 
in a service benefit plan of the Federal Employees Health Benefits 
program.''.
    (2) The table of sections at the beginning of such chapter is 
amended by inserting after the item relating to section 1107 (as added 
by section 201(b)) the following new item:

``1108. CHAMPUS and TRICARE Standard benefits: comparability with 
                            service benefit plan of the Federal 
                            Employees Health Benefits program.''.
    (b) Definitions.--Section 1072 of title 10, United States Code, is 
amended--
            (1) in paragraph (4), by striking out ``The term `Civilian 
        Health and Medical Program of the Uniformed Services' means'' 
        and inserting in lieu thereof ``The terms `Civilian Health and 
        Medical Program of the Uniformed Services' and `CHAMPUS' 
        mean''; and
            (2) by adding at the end the following:
            ``(7) The term `TRICARE program' means the managed health 
        care program that is established by the Secretary of Defense 
        under the authority of this chapter, principally section 1097 
        of this title, and includes the competitive selection of 
        contractors to financially underwrite the delivery of health 
        care services under CHAMPUS.
            ``(8) The term `TRICARE Standard' means a CHAMPUS health 
        care benefits option that, subject to the deductibles and cost-
        sharing requirements under CHAMPUS, pays a share of the cost of 
        covered health care services that are provided by health care 
        providers outside the Federal Government who are not part of 
        the CHAMPUS network of health care providers.
            ``(9) The term `Federal Employee Health Benefits program' 
        means the Federal Employee Health Benefits program under 
        chapter 89 of title 5.''.
                                 <all>