[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4124 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 4124

    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, to permit such persons to enroll in the Federal Employees 
            Health Benefits program, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 29, 2000

Mr. Thornberry introduced the following bill; which was referred to the 
Committee on Ways and Means, and in addition to the Committees on Armed 
     Services, Commerce, and Government Reform, 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, to permit such persons to enroll in the Federal Employees 
            Health Benefits program, and for other purposes.

    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 ``Military Retiree 
Health Care Options 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 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 III--OTHER MATTERS

Sec. 301. Participation of medicare-eligible beneficiaries in certain 
                            Department of Defense pharmacy programs.
Sec. 302. Nationwide enrollment card under the TRICARE program.

     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 an 
        individual--
                    (A) who is--
                            (i) a member or former member of the 
                        uniformed services described in section 1074(b) 
                        of title 10, United States Code;
                            (ii) a dependent of a member described in 
                        subsection (a)(2)(B) or (b) of section 1076 of 
                        that title; or
                            (iii) a dependent of a member who died 
                        while on active duty for a period of more than 
                        30 days;
                    (B) who is entitled to hospital insurance benefits 
                under part A of title XVIII of the Social Security Act 
                (42 U.S.C. 1395 et seq.); and
                    (C) who has attained age 65.
            (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(a) 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.--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, 2000, 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--
            (1) through the TRICARE program to increase the number of 
        Medicare-eligible uniformed services retirees able to enroll in 
        the managed care option of the TRICARE program; and
            (2) in a military medical treatment facility of the 
        uniformed services.
    (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 
section 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) Individuals Enrolled in Part A.--In the case of Medicare-
eligible uniformed services retirees who are 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.), the Secretary of 
Health and Human Services shall reimburse the Secretary of Defense for 
services provided under section 103 at a rate equal to the amount paid 
to a Medicare+Choice organization under part C of this title with 
respect to such an enrollee or a rate equal to the amount that 
otherwise would be payable under XVIII of the Social Security Act on a 
noncapitated basis for the service. In cases in which a payment amount 
may not otherwise be readily computed, the Secretary shall establish 
rules for computing equivalent or comparable payment amounts.
    (b) Individuals Not Enrolled in Part B.-- In the case of Medicare-
eligible uniformed services retirees who are not 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.), the Secretary of 
Health and Human Services shall reimburse the Secretary of Defense for 
services provided under section 103 at a rate equal to the amount that 
otherwise would be payable under title XVIII of the Social Security Act 
on a noncapitated basis for the service. In cases in which a payment 
amount may not otherwise be readily computed, the Secretary shall 
establish rules for computing equivalent or comparable payment amounts.

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 2000 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 adjustment 
        of the payment rate under section 104 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) Applicability.--This section applies to a Medicare-eligible 
uniformed services retiree--
            (1) who 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 FOR CERTAIN UNIFORMED 
              SERVICES RETIREES AND DEPENDENTS.

    (a) Medigap Special Open Enrollment.--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) Applicability.--This section applies to a Medicare-eligible 
uniformed services retiree who was eligible to enroll under part B of 
title XVIII of the Social Security Act.

                  TITLE II--FEHBP OPTION FOR RETIREES

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

    (a) In General.--Section 1108 of title 10, United States Code, is 
amended to read as follows:
``Sec. 1108. 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 eligible 
beneficiaries described in subsection (b) may enroll in health benefits 
plans offered through the Federal Employees Health Benefits program 
under chapter 89 of title 5.
    ``(b) Eligible Beneficiaries; Coverage.--(1) An eligible 
beneficiary under this subsection is--
            ``(A) a member or former member of the uniformed services 
        described in section 1074(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.);
            ``(B) an individual who is a former spouse of a member or 
        former member described in section 1072(2)(F) or 1072(2)(G));
            ``(C) an individual who is--
                    ``(i) a dependent of a deceased member or former 
                member described in section 1076(b) or 1076(a)(2)(B) of 
                this title or of a member who died while on active duty 
                for a period of more than 30 days; and
                    ``(ii) a member of family as defined in section 
                8901(5) of title 5; or
            ``(D) an individual who is--
                    ``(i) a dependent of a living member or former 
                member described in section 1076(b)(1) of this title 
                who is entitled to hospital insurance benefits under 
                part A of title XVIII of the Social Security Act, 
                regardless of the member's or former member's 
                eligibility for such hospital insurance benefits; and
                    ``(ii) a member of family as defined in section 
                8901(5) of title 5.
    ``(2) Eligible beneficiaries may enroll in a Federal Employees 
Health Benefit plan under chapter 89 of title 5 under this section for 
self-only coverage or for self and family coverage which includes any 
dependent of the member or former member who is a family member for 
purposes of such chapter.
    ``(3) A person eligible for coverage under this subsection shall 
not be required to satisfy any eligibility criteria specified in 
chapter 89 of title 5 (except as provided in paragraph (1)(C) or 
(1)(D)) as a condition for enrollment in health benefits plans offered 
through the Federal Employees Health Benefits program under this 
section.
    ``(4) For purposes of determining whether an individual is a member 
of family under paragraph (5) of section 8901 of title 5 for purposes 
of paragraph (1)(C) or (1)(D), a member or former member described in 
section 1076(b) or 1076(a)(2)(B) of this title shall be deemed to be an 
employee under such section.
    ``(5) An eligible beneficiary who is eligible to enroll in the 
Federal Employees Health Benefits program as an employee under chapter 
89 of title 5 is not eligible to enroll in a Federal Employees Health 
Benefits plan under this section.
    ``(c) Prohibition Against Use of MTFs and Enrollment Under 
TRICARE.--Covered beneficiaries under this chapter who are provided 
coverage under this section shall not be eligible to receive care at a 
military medical treatment facility or to enroll in a heath care plan 
under the TRICARE program.
    ``(d) Separate Risk Pools; Charges.--(1) The Director of the Office 
of Personnel Management shall require health benefits plans under 
chapter 89 of title 5 that participate under this section to maintain a 
separate risk pool for purposes of establishing premium rates for 
eligible beneficiaries who enroll in such a plan in accordance with 
this section.
    ``(2) The Director shall determine total subscription charges for 
self only or for family coverage for eligible beneficiaries who enroll 
in a health benefits plan under chapter 89 of title 5 in accordance 
with this section. The subscription charges shall include premium 
charges paid to the plan and amounts described in section 8906(c) 
of title 5 for administrative expenses and contingency reserves.
    ``(e) Government Contributions.--The Secretary of Defense shall be 
responsible for the Government contribution for an eligible beneficiary 
who enrolls in a health benefits plan under chapter 89 of title 5 in 
accordance with this section, except that the amount of the 
contribution may not exceed the amount of the Government contribution 
which would be payable if the electing beneficiary were an employee (as 
defined for purposes of such chapter) enrolled in the same health 
benefits plan and level of benefits.''.
    (b) Conforming Amendments.--(1) The item relating to section 1108 
in the table of sections at the beginning of chapter 55 of title 10, 
United States Code, is amended to read as follows:

``1108. Health care coverage through Federal Employees Health Benefits 
                            program.''.
    (2) Section 724 of the Strom Thurmond National Defense 
Authorization Act for Fiscal Year 1999 (Public Law 105-261; 112 Stat. 
2069) is amended to read as follows:

``SEC. 724. COMPREHENSIVE EVALUATION OF IMPLEMENTATION OF DEMONSTRATION 
              PROJECT AND TRICARE PHARMACY REDESIGN.

    ``Not later than March 31, 2003, the Comptroller General shall 
submit to the Committees on Armed Services of the Senate and the House 
of Representatives a report containing a comprehensive comparative 
analysis of the TRICARE Senior Supplement under section 722 and the 
redesign of the TRICARE pharmacy system under section 723. The 
comprehensive analysis shall incorporate the findings of the evaluation 
submitted under section 723(c).''.
    (3) Chapter 89 of title 5, United States Code, is amended--
            (A) in section 8905(d), by striking ``, as part of the 
        demonstration project under such section,'';
            (B) in section 8906(b)(4)--
                    (i) by striking ``as part of the demonstration 
                project''; and
                    (ii) by striking ``subsection (i)'' and inserting 
                ``subsection (e)'';
            (C) in section 8906(g)(3)--
                    (i) by striking ``as part of the demonstration 
                project''; and
                    (ii) by striking ``subsection (i)'' and inserting 
                ``subsection (e)''; and
            (D) in section 8909(g), by striking ``the demonstration 
        project under''.

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 1109 the following new 
section:
``Sec. 1110. 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.''.
    (2) The table of sections at the beginning of such chapter is 
amended by inserting after the item relating to section 1109 the 
following new item:

``1110. 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:
            ``(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.''.

                        TITLE III--OTHER MATTERS

SEC. 301. PARTICIPATION OF MEDICARE-ELIGIBLE BENEFICIARIES IN CERTAIN 
              DEPARTMENT OF DEFENSE PHARMACY PROGRAMS.

    (a) In General.--Not later than October 1, 2000, the Secretary of 
Defense shall--
            (1) expand and make permanent the demonstration project for 
        pharmaceuticals by mail established under subsection (a) of 
        section 702 of the National Defense Authorization Act for 
        Fiscal Year 1993 (10 U.S.C. 1079 note) in order to permit 
        individuals described in subsection (b) worldwide to obtain 
        pharmaceuticals through the project; and
            (2) modify each managed health care program which includes 
        a managed care network of community retail pharmacies under 
        subsection (b) of such section 702 to supply prescription 
        pharmaceuticals to the individuals described in subsection (b) 
        of this section through such network in the area covered by 
        such program.
    (b) Eligible Individuals.--An individual eligible to obtain 
pharmaceuticals under this section is an individual--
            (1) who is--
                    (A) a member or former member of the uniformed 
                services described in section 1074(b) of title 10, 
                United States Code;
                    (B) a dependent of a member described in subsection 
                (a)(2)(B) or (b) of section 1076 of that title; or
                    (C) a dependent of a member who died while on 
                active duty for a period of more than 30 days;
            (2) who is entitled to hospital insurance benefits under 
        part A of title XVIII of the Social Security Act (42 U.S.C. 
        1395 et seq.); and
            (3) who has attained age 65.
    (c) Fees and Charges.--(1) An eligible individual described in 
subsection (b) shall not be charged an enrollment fee or deductible for 
participation in the project or a retail pharmacy network under this 
section.
    (2) The Secretary of Defense may not establish or collect any new 
fee or charge under the project referred to in subsection (a)(1), or 
any retail pharmacy network referred to in subsection (a)(2), by reason 
of the participation of eligible individuals described in subsection 
(b) in the project or network under this section.

SEC. 302. NATIONWIDE ENROLLMENT CARD UNDER THE TRICARE PROGRAM.

    (a) Requirement.--The Secretary of Defense, after consultation with 
the other administering Secretaries, shall issue to covered 
beneficiaries under the TRICARE program an enrollment card which shall 
serve as an enrollment card for participation in the TRICARE program 
nationwide. The purpose of the enrollment card is to facilitate the 
ready portability of benefits under the TRICARE program.
    (b) Definitions.--In this section the terms ``administering 
Secretaries'' and ``TRICARE program'' shall have the meanings given 
such terms in section 1072 of title 10, United States Code.
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