[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4418 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 4418

 To make various improvements in the military health care system with 
                    respect to the TRICARE program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 10, 2000

Mr. Jones of North Carolina (for himself, Mr. Stenholm, and Mr. Thune) 
 introduced the following bill; which was referred to the Committee on 
                             Armed Services

_______________________________________________________________________

                                 A BILL


 
 To make various improvements in the military health care system with 
                    respect to the TRICARE program.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``TRICARE Enhancement Act of 2000''.

SEC. 2. IMPROVEMENT OF ACCESS TO HEALTH CARE UNDER THE TRICARE PROGRAM.

    (a) Waiver of Nonavailability Statement or Preauthorization.--In 
the case of a covered beneficiary under chapter 55 of title 10, United 
States Code, who is enrolled in TRICARE Standard, the Secretary of 
Defense may not require with regard to authorized health care services 
(other than mental health services) under any new contract for the 
provision of health care services under such chapter that the 
beneficiary--
            (1) obtain a nonavailability statement or preauthorization 
        from a military medical treatment facility in order to receive 
        the services from a civilian provider; or
            (2) obtain a nonavailability statement for care in 
        specialized treatment facilities outside the 200-mile radius of 
        a military medical treatment facility.
    (b) Notice.--The Secretary may require that the covered beneficiary 
inform the primary care manager of the beneficiary of any health care 
received from a civilian provider or in a specialized treatment 
facility.
    (c) Exceptions.--Subsection (a) shall not apply if--
            (1) the Secretary demonstrates significant cost avoidance 
        for specific procedures at the affected military medical 
        treatment facilities;
            (2) the Secretary determines that a specific procedure must 
        be maintained at the affected military medical treatment 
        facility to ensure the proficiency levels of the practitioners 
        at the facility; or
            (3) the lack of nonavailability statement data would 
        significantly interfere with TRICARE contract administration.

SEC. 3. IMPROVEMENTS IN MONITORING ACCESS TO CARE.

    (a) In General.--The Secretary of Defense shall direct--
            (1) that the Composite Health Care System be used in lieu 
        of the Customer Satisfaction Survey to measure performance of 
        the Department of Defense in scheduling appointments in 
        military medical treatment facilities for covered beneficiaries 
        under TRICARE Prime in compliance with appointment access 
        standards of the TRICARE program;
            (2) that any necessary modifications be made to the 
        Composite Health Care System in order that appropriate access 
        standards are used and standardized throughout the military 
        health-care system; and
            (3) that compliance with the appointment timeliness 
        standards under the TRICARE program in military medical 
        treatment facilities be reported at the individual military 
        medical treatment facility level, the service level, the system 
        wide level, and by various beneficiary categories.
    (b) Report Required.--Not later than December 31, 2000, the 
Secretary shall submit to Congress a report on efforts to carry out 
this section.

SEC. 4. EXPANDED ACCESS TO CERTIFIED MENTAL HEALTH COUNSELORS.

    (a) In General.--Section 1079 of title 10, United States Code, is 
amended--
            (1) in subsection (a)--
                    (A) in paragraph (8)--
                            (i) by striking ``or marital counselors 
                        (other than certified marriage and family 
                        therapists)'' and inserting ``marital 
                        counselors (other than certified marriage and 
                        family therapists, or certified mental health 
                        counselors)''; and
                            (ii) by inserting ``and certified mental 
                        health counselors'' after ``services of 
                        certified marriage and family health 
                        therapists''; and
                    (B) in paragraph (13), by inserting ``certified 
                mental health counselor,'' after ``psychologist,''; and
            (2) by adding at the end the following:
    ``(p)(1) For purposes of providing substance abuse treatment 
services to covered beneficiaries under the TRICARE program, the 
Secretary shall recognize certified professional mental health 
counselors as qualified mental health providers who are able to 
prescribe the appropriate level and course of treatment for substance 
abuse disorders.
    ``(2) For purposes of providing mental health evaluations of 
covered beneficiaries under the TRICARE program, the Secretary shall 
recognize certified professional mental health counselors as mental 
health professionals qualified to conduct mental health evaluations.''.
    (b) Application of Amendments.--The amendments made by subsection 
(a) shall apply with respect to services of a certified mental health 
counselor provided under section 1079 or 1086 of title 10, United 
States Code, on or after the date of the enactment of this Act.

SEC. 5. REIMBURSEMENT OF CERTAIN COSTS INCURRED BY COVERED 
              BENEFICIARIES REFERRED FOR CARE OUTSIDE LOCAL CATCHMENT 
              AREA.

    The Secretary of Defense shall require that any new contract for 
the provision of health care services under the TRICARE program under 
chapter 55 of title 10, United States Code, shall require that in any 
case in which a covered beneficiary under such chapter who is enrolled 
in TRICARE Prime is referred by a network provider or military medical 
treatment facility to a provider or military medical treatment facility 
more than 100 miles outside the catchment area of a military medical 
treatment facility because a local provider is not available, the 
beneficiary shall be reimbursed by the network provider or military 
medical treatment facility making the referral for the cost of personal 
automobile mileage, to be paid under standard reimbursement rates for 
Federal employees, or for the cost of air travel in amounts not to 
exceed standard contract fares for Federal employees.

SEC. 6. REMOVAL OF RESTRICTION REGARDING REIMBURSEMENT CAP.

    Section 1097b(a) of title 10, United States Code, is amended by 
adding at the end the following:
    ``(3) In circumstances in which TRICARE Standard is a secondary 
payer for health care provided to a covered beneficiary, TRICARE 
Standard shall provide reimbursement to the health care provider in the 
amount of the difference between the amount paid by the primary 
insurance provider and the total amount of the charges for the health 
care provided to the beneficiary, but in no case--
            ``(A) may the total amount paid by TRICARE Standard exceed 
        115 percent of CHAMPUS maximum allowable charges; or
            ``(B) may the total amount paid by the primary insurance 
        provider and TRICARE Standard exceed the total amount of the 
        charges for the health care provided.''.

SEC. 7. IMPROVEMENTS WITH RESPECT TO PROVISION OF DENTAL CARE.

    (a) Expansion of Appeals Process.--The Secretary of Defense shall 
extend the appeals process for resolution of claims for participating 
dental care providers under the TRICARE program to non-network 
providers who provide dental care to covered beneficiaries under 
chapter 55 of title 10, United States Code, under such program.
    (b) Disenrollment Process for TRICARE Retiree Dental Program.--(1) 
With respect to the provision of dental care to military retirees and 
their dependents under chapter 55 of title 10, United States Code, the 
Secretary of Defense--
            (A) shall require that a contract with a provider allow for 
        a period of not less than 10 business days, beginning on the 
        date of the submission of an application for enrollment, during 
        which the enrollee may disenroll;
            (B) shall provide for limited circumstances under which 
        disenrollment shall be permitted during the 24-month initial 
        enrollment period, without jeopardizing the fiscal integrity of 
        the dental program.
    (2) The circumstances described in paragraph (1)(B) shall include--
            (A) a case in which a military retiree who is also a 
        Federal employee is assigned to a location overseas which 
        prevents utilization of dental benefits in the United States;
            (B) a case in which a military retiree or dependent 
        provides medical documentation with regard to a diagnosis of a 
        serious or terminal illness which precludes the retiree or 
        dependent from obtaining dental care;
            (C) a case in which severe financial hardship would result; 
        and
            (D) any other instances which the Secretary considers 
        appropriate.
    (3) Initial requests for disenrollment under this section shall be 
made to the contractor, and appeals of a decision by the contractor, or 
policies with respect to the provision of dental care to retirees and 
their dependents under the TRICARE program shall, at the request of the 
beneficiary, be referred by the contractor (including all relevant 
information collected by the contractor) to the TRICARE Management 
Activity.

SEC. 8. REPORTS REQUIRED.

    (a) Report on Reimbursement Rates.--Not later than February 1, 
2001, the Secretary of Defense shall submit to Congress a report on the 
use of authority under section 1097b of title 10, United States Code, 
to provide reimbursement to health care providers at rates higher than 
otherwise authorized, but not exceeding an amount equal to 115 percent 
of CHAMPUS maximum allowable charges. The report shall include--
            (1) a description of the rate and incidence of the use of 
        such authority, the locations with respect to which the 
        authority was exercised, and the procedures for which the 
        authority was exercised; and
            (2) an analysis of the adequacy of such authority to 
        improve efficiency in the provision of health care services 
        under the TRICARE program network, particularly with respect to 
        rural and remote areas.
    (b) Report on Comparison of Rates Charged for Medical Procedures.--
Not later than February 1, 2001, the Secretary of Defense shall submit 
to Congress a study on how the maximum allowable rates charged for the 
100 most commonly performed medical procedures under the Civilian 
Health and Medical Program of the Uniformed Services and Medicare 
compare with usual and customary commercial insurance rates for such 
procedures in each TRICARE Prime catchment area.
    (c) Report on Mandatory Reimbursement Floor.--Not later than 
February 1, 2001, the Comptroller General shall submit to Congress a 
report providing an analysis of whether the use of a mandatory floor of 
70 percent of usual and customary rates for reimbursement to health 
care providers under the TRICARE program, rather than a ceiling of an 
amount equal to 115 percent of CHAMPUS maximum allowable charges, would 
assist in providing a more robust health care network.
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