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[1] See References in Text note below.
§ 1395ggg. Medicare subvention demonstration project for military retirees
(a)
Definitions
In this section:
(1)
Administering Secretaries
The term “administering Secretaries” means the Secretary and the Secretary of Defense acting jointly.
(2)
Demonstration project; project
The terms “demonstration project” and “project” mean the demonstration project carried out under this section.
(3)
Designated provider
The term “designated provider” has the meaning given that term in section 721(5) of the National Defense Authorization Act For Fiscal Year 1997 (Public Law 104–201; 110 Stat. 2593; 10 U.S.C. 1073 note ).
(4)
Medicare-eligible military retiree or dependent
The term “medicare-eligible military retiree or dependent” means an individual described in section
1074
(b) or
1076
(b) of title
10 who—
(A)
is eligible for health benefits under section 1086 of such title by reason of subsection (c)(1) of such section;
(5)
Medicare health care services
The term “medicare health care services” means items or services covered under part A or B of this subchapter.
(b)
Demonstration project
(1)
In general
(A)
Establishment
The administering Secretaries are authorized to establish a demonstration project (under an agreement entered into by the administering Secretaries) under which the Secretary shall reimburse the Secretary of Defense, from the trust funds, for medicare health care services furnished to certain medicare-eligible military retirees or dependents in a military treatment facility or by a designated provider.
(B)
Agreement
The agreement entered into under subparagraph (A) shall include at a minimum—
(i)
a description of the benefits to be provided to the participants of the demonstration project established under this section;
(ii)
a description of the eligibility rules for participation in the demonstration project, including any cost sharing requirements;
(iii)
a description of how the demonstration project will satisfy the requirements under this subchapter;
(v)
a description of how reimbursement requirements under subsection (i) of this section and maintenance of effort requirements under subsection (j) of this section will be implemented in the demonstration project;
(vi)
a statement that the Secretary shall have access to all data of the Department of Defense that the Secretary determines is necessary to conduct independent estimates and audits of the maintenance of effort requirement, the annual reconciliation, and related matters required under the demonstration project;
(vii)
a description of any requirement that the Secretary waives pursuant to subsection (d) of this section; and
(viii)
a certification, provided after review by the administering Secretaries, that any entity that is receiving payments by reason of the demonstration project has sufficient—
(2)
Number of sites
The project established under this section shall be conducted in no more than 6 sites, designated jointly by the administering Secretaries after review of all TRICARE regions.
(3)
Restriction
No new military treatment facilities will be built or expanded with funds from the demonstration project.
(4)
Duration
The administering Secretaries shall conduct the demonstration project during the 4-year period beginning on January 1, 1998, except that the administering Secretaries may negotiate and (subject to section 712(f) of the Floyd D. Spence National Defense Authorization Act for Fiscal Year 2001) enter into a new or revised agreement under paragraph (1)(A) to continue the project after the end of such period. If the project is so continued, the administering Secretaries may terminate the agreement under which the program operates after providing notice to Congress in accordance with subsection (k)(2)(B)(v) [1] of this section.
(c)
Crediting of payments
A payment received by the Secretary of Defense under the demonstration project shall be credited to the applicable Department of Defense medical appropriation (and within that appropriation). Any such payment received during a fiscal year for services provided during a prior fiscal year may be obligated by the Secretary of Defense during the fiscal year during which the payment is received.
(d)
Waiver of certain medicare requirements
(1)
Authority
(A)
In general
Except as provided under subparagraph (B), the demonstration project shall meet all requirements of Medicare+Choice plans under part C of this subchapter and regulations pertaining thereto, and other requirements for receiving medicare payments, except that the prohibition of payments to Federal providers of services under sections
1395f
(c) and
1395n
(d) of this title, and paragraphs (2) and (3) of section
1395y
(a) of this title shall not apply.
(B)
Waiver
Except as provided in paragraph (2), the Secretary is authorized to waive any requirement described under subparagraph (A), or approve equivalent or alternative ways of meeting such a requirement, but only if such waiver or approval—
(e)
Inspector General
Nothing in the agreement entered into under subsection (b) of this section shall limit the Inspector General of the Department of Health and Human Services from investigating any matters regarding the expenditure of funds under this subchapter for the demonstration project, including compliance with the provisions of this subchapter and all other relevant laws.
(f)
Voluntary participation
Participation of medicare-eligible military retirees or dependents in the demonstration project shall be voluntary.
(g)
TRICARE health care plans
(1)
Modification of TRICARE contracts
In carrying out the demonstration project, the Secretary of Defense is authorized to amend existing TRICARE contracts (including contracts with designated providers) in order to provide the medicare health care services to the medicare-eligible military retirees and dependents enrolled in the demonstration project consistent with part C of this subchapter.
(2)
Health care benefits
The administering Secretaries shall prescribe the minimum health care benefits to be provided under such a plan to medicare-eligible military retirees or dependents enrolled in the plan. Those benefits shall include at least all medicare health care services covered under this subchapter.
(h)
Additional plans
Notwithstanding any provisions of title 10, the administering Secretaries may agree to include in the demonstration project any of the Medicare+Choice plans described in section
1395w–21
(a)(2)(A) of this title, and such agreement may include an agreement between the Secretary of Defense and the Medicare+Choice organization offering such plan to provide medicare health care services to medicare-eligible military retirees or dependents and for such Secretary to receive payments from such organization for the provision of such services.
(i)
Payments based on regular medicare payment rates
(1)
In general
Subject to the succeeding provisions of this subsection, the Secretary shall reimburse the Secretary of Defense for services provided under the demonstration project at a rate equal to 95 percent of the amount paid to a Medicare+Choice organization under part C of this subchapter with respect to such an enrollee. 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.
(2)
Exclusion of certain amounts
In computing the amount of payment under paragraph (1), the following shall be excluded:
(j)
Maintenance of effort
(1)
Monitoring effect of demonstration program on costs to medicare program
(A)
In general
The administering Secretaries, in consultation with the Comptroller General, shall closely monitor the expenditures made under the medicare program for medicare-eligible military retirees or dependents during the period of the demonstration project compared to the expenditures that would have been made for such medicare-eligible military retirees or dependents during that period if the demonstration project had not been conducted. The agreement entered into by the administering Secretaries under subsection (b) of this section shall require any participating military treatment facility to maintain the level of effort for space available care to medicare-eligible military retirees or dependents.
(B)
Annual report by the Comptroller General
Not later than December 31 of each year during which the demonstration project is conducted, the Comptroller General shall submit to the administering Secretaries and the appropriate committees of Congress a report on the extent, if any, to which the costs of the Secretary under the medicare program under this subchapter increased during the preceding fiscal year as a result of the demonstration project.
(2)
Required response in case of increase in costs
(A)
In general
If the administering Secretaries find, based on paragraph (1), that the expenditures under the medicare program under this subchapter increased (or are expected to increase) during a fiscal year because of the demonstration project, the administering Secretaries shall take such steps as may be needed—
(k)
Evaluation and reports
(1)
Independent evaluation
The Comptroller General of the United States shall conduct an evaluation of the demonstration project, and shall submit annual reports on the demonstration project to the administering Secretaries and to the committees of jurisdiction in the Congress. The first report shall be submitted not later than 12 months after the date on which the demonstration project begins operation, and the final report not later than 31/2 years after that date. The evaluation and reports shall include an assessment, based on the agreement entered into under subsection (b) of this section, of the following:
(A)
Any savings or costs to the medicare program under this subchapter resulting from the demonstration project.
(B)
The cost to the Department of Defense of providing care to medicare-eligible military retirees and dependents under the demonstration project.
(C)
A description of the effects of the demonstration project on military treatment facility readiness and training and the probable effects of the project on overall Department of Defense medical readiness and training.
(D)
Any impact of the demonstration project on access to care for active duty military personnel and their dependents.
(E)
An analysis of how the demonstration project affects the overall accessibility of the uniformed services treatment system and the amount of space available for point-of-service care, and a description of the unintended effects (if any) upon the normal treatment priority system.
(G)
The number of medicare-eligible military retirees and dependents opting to participate in the demonstration project instead of receiving health benefits through another health insurance plan (including benefits under this subchapter).
(H)
A list of the health insurance plans and programs that were the primary payers for medicare-eligible military retirees and dependents during the year prior to their participation in the demonstration project and the distribution of their previous enrollment in such plans and programs.
(I)
Any impact of the demonstration project on private health care providers and beneficiaries under this subchapter that are not enrolled in the demonstration project.
(J)
An assessment of the access to care and quality of care for medicare-eligible military retirees and dependents under the demonstration project.
(K)
An analysis of whether, and in what manner, easier access to the uniformed services treatment system affects the number of medicare-eligible military retirees and dependents receiving medicare health care services.
(L)
Any impact of the demonstration project on the access to care for medicare-eligible military retirees and dependents who did not enroll in the demonstration project and for other individuals entitled to benefits under this subchapter.
(M)
A description of the difficulties (if any) experienced by the Department of Defense in managing the demonstration project and TRICARE contracts.
[1] See References in Text note below.
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Notes
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Parallel authorities (CFR)
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Notes
No Update(s)
Parallel authorities (CFR)
PDF (9 pages)
Title 42 RSS
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