
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 2, 2001]
[Document not affected by Public Laws enacted between
  January 2, 2001 and January 28, 2002]
[CITE: 10USC1097b]

 
                         TITLE 10--ARMED FORCES
 
                    Subtitle A--General Military Law
 
                           PART II--PERSONNEL
 
                   CHAPTER 55--MEDICAL AND DENTAL CARE
 
Sec. 1097b. TRICARE program: financial management

    (a) Reimbursement of Providers.--(1) Subject to paragraph (2), the 
Secretary of Defense may reimburse health care providers under the 
TRICARE program at rates higher than the reimbursement rates otherwise 
authorized for the providers under that program if the Secretary 
determines that application of the higher rates is necessary in order to 
ensure the availability of an adequate number of qualified health care 
providers under that program.
    (2) The amount of reimbursement provided under paragraph (1) with 
respect to a health care service may not exceed the lesser of the 
following:
        (A) The amount equal to the local fee for service charge for the 
    service in the service area in which the service is provided as 
    determined by the Secretary based on one or more of the following 
    payment rates:
            (i) Usual, customary, and reasonable.
            (ii) The Health Care Finance Administration's Resource Based 
        Relative Value Scale.
            (iii) Negotiated fee schedules.
            (iv) Global fees.
            (v) Sliding scale individual fee allowances.

        (B) The amount equal to 115 percent of the CHAMPUS maximum 
    allowable charge for the service.

    (b) Third-Party Collections.--(1) A medical treatment facility of 
the uniformed services under the TRICARE program has the same right as 
the United States under section 1095 of this title to collect from a 
third-party payer the reasonable charges for health care services 
described in paragraph (2) that are incurred by the facility on behalf 
of a covered beneficiary under that program.
    (2) The Secretary of Defense shall prescribe regulations for the 
administration of this subsection. The regulations shall set forth the 
method to be used for the computation of the reasonable charges for 
inpatient, outpatient, and other health care services. The method of 
computation may be--
        (A) a method that is based on--
            (i) per diem rates;
            (ii) all-inclusive rates for each visit;
            (iii) diagnosis-related groups; or
            (iv) rates prescribed under the regulations implementing 
        sections 1079 and 1086 of this title; or

        (B) any other method considered appropriate.

    (c) Consultation Requirement.--The Secretary of Defense shall carry 
out the responsibilities under this section after consultation with the 
other administering Secretaries.

(Added Pub. L. 106-65, div. A, title VII, Sec. 716(a)(1), Oct. 5, 1999, 
113 Stat. 690.)


                             Effective Date

    Pub. L. 106-65, div. A, title VII, Sec. 716(d), Oct. 5, 1999, 113 
Stat. 692, provided that: ``The amendments made by subsection (a) 
[enacting this section] shall take effect one year after the date of the 
enactment of this Act [Oct. 5, 1999].''


                        Report on Implementation

    Pub. L. 106-65, div. A, title VII, Sec. 716(b), Oct. 5, 1999, 113 
Stat. 691, provided that:
    ``(1) Not later than 6 months after the date of the enactment of 
this Act [Oct. 5, 1999], the Secretary of Defense, in consultation with 
the other administering Secretaries, shall submit to Congress a report 
assessing the effects of the implementation of the requirements and 
authorities set forth in sections [sic] 1097b of title 10, United States 
Code (as added by subsection (a)).
    ``(2) The report shall include the following:
        ``(A) An assessment of the cost of the implementation of such 
    requirements and authorities.
        ``(B) An assessment of whether the implementation of any such 
    requirements and authorities will result in the utilization by the 
    TRICARE program of the best industry practices with respect to the 
    matters covered by such requirements and authorities.
    ``(3) In this subsection, the term `administering Secretaries' has 
the meaning given that term in section 1072(3) of title 10, United 
States Code.''
