[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 2087 Introduced in Senate (IS)]







106th CONGRESS
  2d Session
                                S. 2087

 To amend title 10, United States Code, to improve access to benefits 
under the TRICARE program; to extend and improve certain demonstration 
   programs under the Defense Health Program; and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           February 23, 2000

    Mr. Warner (for himself, Mr. Lott, Mr. Levin, Mr. Daschle, Mr. 
  Hutchinson, Mr. Cleland, Mr. Thurmond, Mr. Kennedy, Mr. Inhofe, Mr. 
   Santorum, Ms. Snowe, Mr. Roberts, Mr. Allard, Mrs. Hutchison, Mr. 
Lieberman, Ms. Landrieu, Mr. Reed, Mr. Crapo, Mr. Inouye, Mrs. Lincoln, 
and Mr. Kerry) introduced the following bill; which was read twice and 
              referred to the Committee on Armed Services

_______________________________________________________________________

                                 A BILL


 
 To amend title 10, United States Code, to improve access to benefits 
under the TRICARE program; to extend and improve certain demonstration 
   programs under the Defense Health 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.

    This Act may be cited as the ``Military Health Care Improvements 
Act of 2000''.

                    TITLE I--DEMONSTRATION PROGRAMS

         Subtitle A--TRICARE Demonstration Programs for Seniors

SEC. 101. EXTENSION OF TRICARE SENIOR SUPPLEMENT PROGRAM.

    Section 722(a)(2) of the Strom Thurmond National Defense 
Authorization Act for Fiscal Year 1999 (Public Law 105-261; 112 Stat. 
2065; 10 U.S.C. 1073 note) is amended by striking ``December 31, 2002'' 
and inserting ``December 31, 2005''.

SEC. 102. TRICARE SENIOR PRIME.

    (a) Extension of Demonstration Program.--Paragraph (4) of section 
1896(b) of the Social Security Act (42 U.S.C. 1395ggg(b)) is amended by 
striking ``3-year period beginning on January 1, 1998'' and inserting 
``period beginning on January 1, 1998, and ending on December 31, 
2005''.
    (b) Addition of Major Medical Centers.--Paragraph (1)(A) of such 
section 1895(b) is amended by striking ``in a military treatment 
facility'' and inserting ``in a Department of Defense medical center 
considered by the Secretary to be a major medical center, in any other 
military treatment facility,''.
    (c) Designation of Additional Sites.--Paragraph (2) of such section 
1896(b) is amended to read as follows:
            ``(2) Designation of sites.--
                    ``(A) In general.--The project established under 
                this section shall be conducted at sites designated 
                jointly by the administering Secretaries after review 
                of all TRICARE regions.
                    ``(B) Specific sites.--The sites for the project 
                shall include the 6 sites designated in accordance with 
                subparagraph (A) before the date of the enactment of 
                the National Defense Authorization Act for Fiscal Year 
                2001 and the major medical centers designated after 
                such date in accordance with that subparagraph.''.

                Subtitle B--Other Demonstration Programs

SEC. 106. COVERAGE BY FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM.

    (a) Extension of Coverage for Retirees Over Age 65.--(1) Section 
1108 of title 10, United States Code, is amended by adding at the end 
the following:
    ``(m) Extension of Coverage for Retirees Over Age 65.--(1) Eligible 
beneficiaries referred to in subsection (b)(1) who will be at least 65 
years of age on December 31, 2002, shall be permitted to enroll, or to 
extend a previous enrollment entered into under subsection (d)(2), 
during a period of open enrollment for the year 2003 (conducted in the 
fall of 2002).
    ``(2) Subject to paragraphs (2) and (3) of subsection (f), the 
period of enrollment, or extension of enrollment, of an eligible 
beneficiary under paragraph (1) shall be two years unless the 
beneficiary disenrolls before the termination of the demonstration 
project.
    ``(3) The agreement under subsection (a) shall provide for 
continuation of the demonstration project for a total of five contract 
years under the Federal Employees Health Benefits program for eligible 
beneficiaries referred to in paragraph (1).''.
    (2) Subsection (d) of such section is amended--
            (A) in paragraph (1), by striking ``three contract years'' 
        and inserting ``six contract years''; and
            (B) in paragraph (2), by striking ``December 31, 2002'' in 
        the second sentence and inserting ``December 31, 2005''.
    (3) Subsection (f)(1) of such section is amended by adding at the 
end the following: ``A beneficiary may not extend the enrollment unless 
eligible to do so under subsection (m)(1).''.
    (b) Additional Areas of Coverage.--Subsection (c) of such section 
is amended--
            (1) by striking ``, but not more than ten,''; and
            (2) by striking the third sentence and inserting the 
        following: ``In establishing the areas, the Secretary and 
        Director shall include an area that includes the catchment area 
        of one or more military medical treatment facilities, an area 
        that is not located in the catchment area of a military medical 
        treatment facility, an area in which there is a Medicare 
        Subvention Demonstration project area under section 1896 of 
        title XVIII of the Social Security Act (42 U.S.C. 1395ggg), and 
        one area for each TRICARE region. Each area selected after the 
        date of the enactment of the National Defense Authorization Act 
        for Fiscal Year 2001 shall be an area that is not located in 
        the catchment area of a military medical treatment facility.''.

SEC. 107. IMPLEMENTATION OF REDESIGNED PHARMACY SYSTEM.

    (a) Enrollment Fee and Deductibles Required.--Subsection (b) of 
section 723 of the Strom Thurmond National Defense Authorization Act 
for Fiscal Year 1999 (Public Law 105-261; 112 Stat. 2068; 10 U.S.C. 
1073 note) is amended to read as follows:
    ``(b) Enrollment Fees, Deductibles, and Other Charges.--(1) The 
Secretary may require each eligible individual described in subsection 
(e) who participates in the redesigned pharmacy system to pay an 
enrollment fee. The Secretary shall ensure that any such enrollment fee 
required after December 31, 2000, is lower than the enrollment fee 
charged under this subsection on such date.
    ``(2) The Secretary may also impose one or more cost-sharing 
requirements for each individual referred to in paragraph (1) for 
benefits under the redesigned pharmacy system as follows:
            ``(A) An annual deductible requirement for each such 
        individual.
            ``(B) Any premiums, copayments, or other charges that the 
        Secretary would otherwise collect from individuals similar to 
        such individual.''.
    (b) Periodic Payment of Premiums.--Subsection (b) of such section 
is further amended by adding at the end the following:
    ``(2) An individual may elect to pay a premium charged under this 
subsection on a monthly or quarterly basis.''.
    (c) Effective Date.--The amendments made by this section shall take 
effect on January 1, 2001, and shall apply with respect to 
participation in the redesigned pharmacy system under section 723 of 
Public Law 105-261 for months beginning on or after that date.

             TITLE II--TRICARE PRIME PERMANENT AUTHORITIES

SEC. 201. ADDITIONAL BENEFICIARIES UNDER TRICARE PRIME REMOTE PROGRAM 
              IN CONUS.

    (a) Coverage of Other Uniformed Services.--(1) Section 1074(c) of 
title 10, United States Code, is amended--
            (A) by striking ``armed forces'' each place it appears, 
        except in paragraph (3)(A), and inserting ``uniformed 
        services'';
            (B) in paragraph (1), by inserting after ``military 
        department'' in the first sentence the following: ``, the 
        Department of Transportation (with respect to the Coast Guard 
        when it is not operating as a service in the Navy), or the 
        Department of Health and Human Services (with respect to the 
        National Oceanic and Atmospheric Administration and the Public 
        Health Service)'';
            (C) in paragraph (2), by adding at the end the following:
            ``(C) The Secretary of Defense shall consult with the other 
        administering Secretaries in the administration of this 
        paragraph.''; and
            (D) in paragraph (3)(A), by striking ``The Secretary of 
        Defense may not require a member of the armed forces described 
        in subparagraph (B)'' and inserting ``A member of the uniformed 
        services described in subparagraph (B) may not be required''.
    (2)(A) Subsections (b), (c), and (d)(3) of section 731 of the 
National Defense Authorization Act for Fiscal Year 1998 (Public Law 
105-85; 111 Stat. 1811; 10 U.S.C. 1074 note) are amended by striking 
``Armed Forces'' and inserting ``uniformed services''.
    (B) Subsection (b) of such section is further amended by adding at 
the end the following:
    ``(4) The Secretary of Defense shall consult with the other 
administering Secretaries in the administration of this subsection.''.
    (C) Subsection (f) of such section is amended by adding at the end 
the following:
            ``(3) The terms `uniformed services' and `administering 
        Secretaries' have the meanings given those terms in section 
        1072 of title 10, United States Code.''.
    (3) Section 706(b) of the National Defense Authorization Act for 
Fiscal Year 2000 (Public Law 106-65; 113 Stat. 684) is amended by 
striking ``Armed Forces'' and inserting ``uniformed services (as 
defined in section 1072(1) of title 10, United States Code)''.
    (b) Coverage of Immediate Family.--(1) Section 1079 of title 10, 
United States Code, is amended by adding at the end the following:
    ``(p)(1) Subject to such exceptions as the Secretary of Defense 
considers necessary, coverage for medical care under this section for 
the dependents referred to in subsection (a) of a member of the 
uniformed services referred to in section 1074(c)(3) of this title who 
are residing with the member, and standards with respect to timely 
access to such care, shall be comparable to coverage for medical care 
and standards for timely access to such care under the managed care 
option of the TRICARE program known as TRICARE Prime.
    ``(2) The Secretary of Defense shall enter into arrangements with 
contractors under the TRICARE program or with other appropriate 
contractors for the timely and efficient processing of claims under 
this subsection.
    ``(3) The Secretary of Defense shall consult with the other 
administering Secretaries in the administration of this subsection.''.
    (2) Section 731(b) of the National Defense Authorization Act for 
Fiscal Year 1998 (Public Law 105-85; 111 Stat. 1811; 10 U.S.C. 1074 
note) is amended--
            (A) in paragraph (1), by adding at the end the following: 
        ``A dependent of the member, as described in subparagraph (A), 
        (D), or (I) of section 1072(2) of title 10, United States Code, 
        who is residing with the member shall have the same entitlement 
        to care and to waiver of charges as the member.''; and
            (B) in paragraph (2), by inserting ``or dependent of the 
        member, as the case may be,'' after ``(2) A member''.
    (c) Effective Date.--(1) The amendments made by subsection (a)(2), 
with respect to members of the uniformed services, and the amendments 
made by subsection (b)(2), with respect to dependents of members, shall 
take effect on the date of the enactment of this Act and shall expire 
with respect to a member or the dependents of a member, respectively, 
on the later of the following:
            (A) The date that is one year after the date of the 
        enactment of this Act.
            (B) The date on which the amendments subsection (a)(1) or 
        (b)(1) apply with respect to the coverage of medical care for 
        and provision of such care to the member or dependents, 
        respectively.
    (2) Section 731(b)(3) of Public Law 105-85 does not apply to a 
member of the Coast Guard, the National Oceanic and Atmospheric 
Administration, or the Commissioned Corps of the Public Health Service, 
or to a dependent of a member of a uniformed service.

SEC. 202. ELIMINATION OF COPAYMENTS FOR IMMEDIATE FAMILY.

    (a) No Copayment for Immediate Family.--Section 1097a of title 10, 
United States Code, is amended--
            (1) by redesignating subsection (e) as subsection (f); and
            (2) by inserting after subsection (d) the following new 
        subsection (e):
    ``(e) No Copayment for Immediate Family.--No copayment shall be 
charged a member for care provided under TRICARE Prime to a dependent 
of a member of the uniformed services described in subparagraph (A), 
(D), or (I) of section 1072 of this title.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
take effect on October 1, 2000, and shall apply with respect to care 
provided on or after that date.

SEC. 203. IMPROVEMENT IN BUSINESS PRACTICES IN THE ADMINISTRATION OF 
              THE TRICARE PROGRAM.

    (a) Requirement.--Not later than October 1, 2001, the Secretary of 
Defense shall take actions that the Secretary considers appropriate to 
improve the business practices used in administering the access of 
eligible persons to health care services through the TRICARE program 
under chapter 55 of title 10, United States Code, including the 
practices relating to the following:
            (1) The availability and scheduling of appointments.
            (2) The filing, processing, and payment of claims.
            (3) Public relations efforts that are focused on outreach 
        to eligible persons.
            (4) The continuation of enrollments without expiration.
            (5) The portability of enrollments nationwide.
    (b) Consultation.--The Secretary of Defense shall consult with the 
other administering Secretaries in the development of the actions to be 
taken under subsection (a).
    (c) Report.--Not later than March 15, 2001, the Secretary of 
Defense shall submit to the Committees on Armed Services of the Senate 
and House of Representatives a report on the actions to be taken under 
subsection (a).
    (d) 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.

            TITLE III--OTHER DEFENSE HEALTH PROGRAM MATTERS

SEC. 301. NATIONAL MAIL ORDER PHARMACY PROGRAM.

    (a) Establishment.--(1) Chapter 55 of title 10, United States Code, 
is amended by adding at the end the following:
``Sec. 1110. Mail order pharmaceuticals
    ``(a) Requirement.--(1) The Secretary of Defense shall carry out a 
program that permits eligible persons described in subsection (b) to 
obtain prescription pharmaceuticals by mail.
    ``(b) Eligible Persons.--A person is eligible to obtain 
pharmaceuticals under the program if the person--
            ``(1) is 65 years of age or older;
            ``(2) would be eligible for medical care under a contract 
        for medical care entered into under section 1086 of this title 
        except for the operation of subsection (d)(1) of such section; 
        and
            ``(3) is enrolled in the supplemental medical insurance 
        program under part B of title XVIII of the Social Security Act 
        (42 U.S.C. 1395j et seq.).
    ``(c) Pharmaceuticals Offered.--The Secretary of Defense shall 
determine the pharmaceuticals that may be obtained by eligible persons 
under the program.
    ``(d) Annual Deductible.--The Secretary of Defense may impose an 
annual deductible requirement for each person obtaining pharmaceuticals 
under the program. The amount of any annual deductible imposed under 
this subsection may not exceed $150.
    ``(e) Consultation Requirement.--The Secretary of Defense shall 
consult with the other administering Secretaries in carrying out the 
program, including in the determining of the pharmaceuticals that may 
be obtained under the program.''.
    (2) The table of sections at the beginning of such chapter is 
amended by adding at the end the following:

``1110. Mail order pharmaceuticals.''.
    (b) Commencement of Program.--The program required by section 1110 
of title 10, United States Code (as added by subsection (a)), shall 
commence not later than the first day of the first month that begins on 
or after the date that is 180 days after the date of the enactment of 
this Act.
    (c) Relationship to Demonstration Project.--The program carried out 
under section 1110 of title 10, United States Code (as added by 
subsection (a)), is in addition to the demonstration project carried 
out under section 702 of the National Defense Authorization Act for 
Fiscal Year 1993 (Public Law 102-484; 106 Stat. 2431; 10 U.S.C. 1079 
note).

SEC. 302. PROVISION OF DOMICILIARY AND CUSTODIAL CARE FOR CHAMPUS 
              BENEFICIARIES.

    (a) Continuation of Care for Certain CHAMPUS Beneficiaries.--
Subsection (a)(3) of section 703 of the National Defense Authorization 
Act for Fiscal Year 2000 (Public Law 106-65; 113 Stat. 682; 10 U.S.C. 
1077 note) is amended to read as follows:
    ``(3) As used in this section, the term `eligible beneficiary' 
means the following:
            ``(A) A covered beneficiary (as that term is defined in 
        section 1072 of title 10, United States Code) who, before the 
        effective date of final regulations to implement the individual 
        case management program authorized by section 1079(a)(17) of 
        such title was provided domiciliary or custodial care services 
        for which the Secretary provided payment.
            ``(B) A person who formerly was an eligible beneficiary 
        under subparagraph (A) and is enrolled in the TRICARE Senior 
        Prime plan under the medicare subvention demonstration project 
        for military retirees carried out under section 1896 of the 
        Social Security Act (42 U.S.C. 1395ggg).''.
    (b) Cost Limitation.--Such section 703 is further amended by adding 
at the end the following:
    ``(e) Cost Limitation.--The total amount expended for services 
provided under subsection (a) for eligible beneficiaries may not exceed 
$100,000,000 in fiscal year 2000 or any fiscal year thereafter.''.

SEC. 303. STUDIES OF ACCRUAL FINANCING FOR HEALTH CARE FOR MILITARY 
              RETIREES.

    (a) Studies Required.--The Secretary of Defense shall carry out two 
studies to assess the feasibility and desirability of financing the 
military health care program for retirees of the uniformed services on 
an accrual basis.
    (b) Sources of Studies.--The Secretary shall provide for--
            (1) one of the studies under subsection (a) to be conducted 
        by one or more Department of Defense organizations designated 
        by the Secretary; and
            (2) the other study to be conducted by an organization that 
        is independent of the Department of Defense and has expertise 
        in financial programs and health care.
    (c) Reports.--(1) The Secretary shall provide for the submission of 
a final report on each study to the Secretary within such time as the 
Secretary determines necessary to satisfy the requirement in paragraph 
(2).
    (2) The Secretary shall transmit the final reports on the studies 
to Congress not later than February 8, 2001. The Secretary may include 
in the transmittal any comments on the reports or on the matters 
studied that the Secretary considers appropriate.

   TITLE IV--JOINT DEPARTMENT OF DEFENSE AND DEPARTMENT OF VETERANS 
                          AFFAIRS INITIATIVES

SEC. 401. TRACKING PATIENT SAFETY IN MILITARY AND VETERANS HEALTH CARE 
              SYSTEMS.

    (a) Centralized Tracking Process.--The Secretary of Defense and the 
Secretary of Veterans Affairs shall jointly prescribe a centralized 
process for the reporting, compiling, and analysis of errors in the 
provision of health care under the Defense Health Program and the 
Department of Veterans Affairs health care system that endanger 
patients beyond the normal risks associated with the care and treatment 
of the patients.
    (b) Safety Indicators, Et Cetera.--The process shall include such 
indicators, standards, and protocols as the Secretary of Defense and 
the Secretary of Veterans Affairs consider necessary for the 
establishment and administration of an effective process.

SEC. 402. PHARMACEUTICAL IDENTIFICATION TECHNOLOGY.

    (a) Bar Code Identification Technology.--The Secretary of Defense 
and the Secretary of Veterans Affairs shall jointly develop a system 
for the use of bar codes for the identification of pharmaceuticals.
    (b) Use in National Mail Order Pharmaceuticals Demonstration 
Project.--The Secretary of Defense, in consultation with the Secretary 
of Veterans Affairs, shall experiment with the use of bar code 
identification of pharmaceuticals in the administration of the mail 
order pharmaceutical demonstration project being carried out under 
section 702 of the National Defense Authorization Act for Fiscal Year 
1993 (Public Law 102-484; 106 Stat. 2431; 10 U.S.C. 1079 note).
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