Official Summaries

TRICARE OBGYN Treatment and Access without Lags in Care Act or the TOTAL Care Act

This bill requires the Department of Defense (DOD) to implement a five-year pilot program under which female beneficiaries enrolled in TRICARE Prime may receive obstetrical and gynecological care without a referral. (Generally, the TRICARE Prime program requires a beneficiary to obtain a referral for care through a designated primary care manager.)

Under the pilot program, participating female beneficiaries may elect to designate an obstetrical or gynecological care provider under the TRICARE program (i.e., the various programs carried out by DOD, including TRICARE Prime) as an additional designated primary care manager.

Current Full Text

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1699 Introduced in House (IH)]

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119th CONGRESS
  1st Session
                                H. R. 1699

 To direct the Secretary of Defense to carry out a pilot program under 
     which a TRICARE Prime beneficiary may access obstetrical and 
     gynecological care without a referral, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 27, 2025

 Mr. Horsford (for himself, Ms. Houlahan, Ms. Salazar, Ms. Strickland, 
Ms. Jacobs, Ms. Tokuda, Mr. Turner of Ohio, Mr. Johnson of Georgia, Ms. 
 Goodlander, and Ms. McBride) introduced the following bill; which was 
              referred to the Committee on Armed Services

_______________________________________________________________________

                                 A BILL


 
 To direct the Secretary of Defense to carry out a pilot program under 
     which a TRICARE Prime beneficiary may access obstetrical and 
     gynecological care without a referral, 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 ``TRICARE OBGYN Treatment and Access 
without Lags in Care Act'' or the ``TOTAL Care Act''.

SEC. 2. PILOT PROGRAM ON ACCESS TO OBSTETRICAL AND GYNECOLOGICAL CARE 
              UNDER TRICARE PRIME PROGRAM.

    (a) Pilot Program.--Beginning not later than 180 days after the 
date of the enactment of this Act, the Secretary of Defense shall carry 
out a pilot program under which--
            (1) the referral requirement in section 1095f(a)(1) of 
        title 10, United States Code, does not apply with respect to 
        obstetrical and gynecological care for covered participants, 
        including the ordering of related obstetrical and gynecological 
        items and services; and
            (2) covered participants may elect to designate an 
        obstetrical or gynecological care provider under the TRICARE 
        program as an additional designated primary care manager under 
        such section.
    (b) Duration.--The Secretary shall carry out the pilot program for 
a period of five years.
    (c) Report.--Not later than four years after the date of the 
enactment of this Act, the Secretary shall submit to the congressional 
defense committees a report on the pilot program that includes the 
following:
            (1) An assessment of any increases or decreases to TRICARE 
        Prime enrollment during the period in which the Secretary 
        carries out the pilot program.
            (2) An assessment of any changes in the associated costs of 
        providing obstetrical and gynecological care under TRICARE 
        Prime.
            (3) Any other matters the Secretary determines appropriate.
    (d) Definitions.--In this section:
            (1) The term ``congressional defense committees'' has the 
        meaning given that term in section 101(a)(16) of title 10, 
        United States Code.
            (2) The term ``covered participant'' means a female 
        beneficiary enrolled in TRICARE Prime who elects to participate 
        in the pilot program.
            (3) The terms ``TRICARE Prime'' and ``TRICARE program'' 
        have the meaning given those terms in section 1072 of title 10, 
        United States Code.
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