Bill Details
Status
Latest action
2025-01-31 - Referred to the House Committee on Armed Services.
Introduced Date
2025-01-31
Policy Area
Armed Forces and National Security
Committees
View committees (1)
Cosponsors
View cosponsors (2)
8
0
0
AI Summary This summary was generated by AI from the bill text. AI can get information wrong.
This bill would change how the military health care program TRICARE pays doctors, hospitals, and other providers for care and services. If more than one payment rate could apply, the Defense Department would have to pay the lowest rate allowed. The bill also requires TRICARE payment rates to be set based on where the care is actually given, not just where the provider’s main office is located. That means the payment rules would be different for care given in places like a hospital, a hospital outpatient department, a surgery center, or a doctor’s office. The goal is to make TRICARE payments more specific to the location of the service and reduce higher payments when lower ones are allowed. These changes would start on January 1, 2026.
- TRICARE would pay the lowest allowed reimbursement rate when more than one rate could apply.
- Payment rates would have to be based on the exact place where care was provided, such as an inpatient hospital, outpatient hospital department, ambulatory surgical center, or physician’s office.
- The billing claim would need a location-specific provider identifier so TRICARE can tell where the care was given.
- The new rules would take effect on January 1, 2026.
Official Summaries
No summaries available
Current Full Text
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 873 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 873
To amend title 10, United States Code, to modify the rate of pay for
care or services provided under the TRICARE program based on the
location at which such care or services were provided.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
January 31, 2025
Mr. McCormick introduced the following bill; which was referred to the
Committee on Armed Services
_______________________________________________________________________
A BILL
To amend title 10, United States Code, to modify the rate of pay for
care or services provided under the TRICARE program based on the
location at which such care or services were provided.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. TRICARE REIMBURSEMENT RATES.
(a) Rates.--Section 1097b(a) of title 10, United States Code, is
amended--
(1) in paragraph (1), by inserting ``and paragraph (3)(A)''
after ``Subject to paragraph (2)''; and
(2) in paragraph (3), by striking ``In establishing'' and
inserting the following:
``(A)(i) Except as provided by paragraph (1), if the Secretary may
determine among more than one reimbursement rate to pay a health care
provider for care or services provided under the TRICARE program, the
Secretary shall pay the lowest rate authorized for such care or
services.
``(ii) The Secretary shall establish reimbursement rates for care
or services paid to health care providers under the TRICARE program
that are specific with respect to the following locations at which the
care or services were provided (regardless of the location of the
headquarters of the health care provider):
``(I) An inpatient hospital.
``(II) An on-campus hospital outpatient department.
``(III) An off-campus hospital outpatient department.
``(IV) An ambulatory surgical center.
``(V) The office of a physician.
``(iii) The Secretary shall ensure that a claim for reimbursement
includes a unique, geographically specific national provider identifier
code that identifies the location of the provider as described in
clause (ii).
``(B) In establishing''.
(b) Effective Date.--The amendments made by subsection (a) shall
take effect on January 1, 2026.
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