[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 2486 Introduced in Senate (IS)]







106th CONGRESS
  2d Session
                                S. 2486

 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

                              May 1, 2000

Mr. Warner (for himself, Mr. Lott, Mr. Thurmond, Mr. Inhofe, Ms. Snowe, 
   Mr. Allard, Mr. Hutchinson, Mr. Craig, Mr. Gregg, Mr. Bond, Mrs. 
 Hutchison, Mr. Crapo, Mr. Helms, Mr. Daschle, Mr. Levin, Mr. Kennedy, 
Mr. Lieberman, Mr. Inouye, Mr. Mack, Mr. Reed, Mr. Cleland, Mr. Kerry, 
Mr. Roberts, and Mr. Santorum) 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--SENIOR HEALTH CARE

SEC. 101. EXTENSION OF TRICARE SENIOR SUPPLEMENT DEMONSTRATION 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 DEMONSTRATION PROGRAM.

    (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.''.

SEC. 103. COVERAGE OF RETIREES OVER AGE 64 BY FEDERAL EMPLOYEES HEALTH 
              BENEFITS PROGRAM.

    (a) Extension of Coverage for Retirees Over Age 64.--(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 64.--(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 three 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. 104. 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 PROGRAM

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--JOINT INITIATIVES WITH DEPARTMENT OF VETERANS AFFAIRS

SEC. 301. 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. 302. 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).

                        TITLE IV--OTHER MATTERS

SEC. 401. PERMANENT AUTHORITY FOR CERTAIN PHARMACEUTICAL BENEFITS.

    (a) Authority.--(1) Chapter 55 of title 10, United States Code, is 
amended by adding at the end the following:
``Sec. 1110. Pharmaceutical benefits
    ``(a) Pharmaceuticals by Mail.--The Secretary of Defense shall 
authorize eligible persons to obtain prescription pharmaceuticals by 
mail in connection with medical care furnished to such persons under 
this chapter.
    ``(b) Retail Pharmacy Network.--To the maximum extent practicable, 
the Secretary of Defense shall include in each managed health care 
program under this chapter, a program to supply prescription 
pharmaceuticals to eligible persons through a managed care network 
of community retail pharmacies in the area covered by the managed 
health care program.
    ``(c) Eligible Persons.--A person is eligible to obtain 
pharmaceuticals under the program of pharmaceuticals by mail under 
subsection (a) or through a retail pharmacy network included in a 
managed health care program under subsection (b) as follows:
            ``(1) A person who is eligible for medical care under a 
        contract for medical care entered into by the Secretary of 
        Defense under section 1079 or 1086 of this title.
            ``(2) A person who 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.
    ``(d) Pharmaceuticals Offered.--The Secretary of Defense shall 
determine the pharmaceuticals that may be obtained by eligible persons 
under subsection (a) or (b).
    ``(e) Fees.--The Secretary of Defense shall prescribe an 
appropriate fee, charge, or copayment to be paid by persons for 
pharmaceuticals obtained under subsection (a) or (b).
    ``(f) Consultation Requirement.--The Secretary of Defense shall 
consult with the other administering Secretaries in the administration 
of this section.''.
    (2) The table of sections at the beginning of such chapter is 
amended by adding at the end the following:

``1110. Pharmaceutical benefits.''.
    (b) Repeal of Superseded Authority.--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) is repealed.
    (c) Effective Date.--This section and the amendments made by this 
section shall take effect on January 1, 2001.

SEC. 402. PROVISION OF DOMICILIARY AND CUSTODIAL CARE FOR CHAMPUS 
              BENEFICIARIES.

    (a) Continuation of Care for Certain CHAMPUS Beneficiaries.--
Section 703(a)(1) 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 by inserting before the period at the end the following: ``or 
by the prohibition in section 1086(d)(1) of such title''.
    (b) Cost Limitation for Individual Case Management Program.--(1) 
Section 1079(a)(17) of title 10, United States Code, is amended--
            (A) by inserting ``(A)'' after ``(17)''; and
            (B) by adding at the end the following:
            ``(B) The total amount expended under subparagraph (A) for 
        a fiscal year may not exceed $100,000,000.''.
    (2) Section 703 of the National Defense Authorization Act for 
Fiscal Year 2000 is amended by adding at the end the following:
    ``(e) Cost Limitation.--The total amount paid for services for 
eligible beneficiaries under subsection (a) for a fiscal year (together 
with the costs of administering the authority under that subsection) 
shall be included in the expenditures limited by section 1079(a)(17)(B) 
of title 10, United States Code.''.
    (2) The amendments made by paragraphs (1) and (2) shall apply to 
fiscal years after fiscal year 1999.

SEC. 403. 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.
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