2013 US Code
Title 10 - Armed Forces
Subtitle A - General Military Law (§§ 101 - 2925)
Part II - PERSONNEL (§§ 501 - 1805)
Chapter 55 - MEDICAL AND DENTAL CARE (§§ 1071 - 1110b)
Section 1097b - TRICARE program: financial management
Publication Title | United States Code, 2012 Edition, Supplement 1, Title 10 - ARMED FORCES |
Category | Bills and Statutes |
Collection | United States Code |
SuDoc Class Number | Y 1.2/5: |
Contained Within | Title 10 - ARMED FORCES Subtitle A - General Military Law PART II - PERSONNEL CHAPTER 55 - MEDICAL AND DENTAL CARE Sec. 1097b - TRICARE program: financial management |
Contains | section 1097b |
Date | 2013 |
Laws in Effect as of Date | January 16, 2014 |
Positive Law | Yes |
Disposition | standard |
Source Credit | Added Pub. L. 106-65, div. A, title VII, §716(a)(1), Oct. 5, 1999, 113 Stat. 690; amended Pub. L. 112-81, div. A, title VII, §715, Dec. 31, 2011, 125 Stat. 1477. |
Statutes at Large References | 113 Stat. 690, 691, 692 125 Stat. 1477 |
Public Law References | Public Law 106-65, Public Law 112-81 |
Download PDF
(a)
(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.
(3) In establishing rates and procedures for reimbursement of providers and other administrative requirements, including those contained in provider network agreements, the Secretary shall, to the extent practicable, maintain adequate networks of providers, including institutional, professional, and pharmacy. For the purpose of determining whether network providers under such provider network agreements are subcontractors for purposes of the Federal Acquisition Regulation or any other law, a TRICARE managed care support contract that includes the requirement to establish, manage, or maintain a network of providers may not be considered to be a contract for the performance of health care services or supplies on the basis of such requirement.
(b)
(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)
(Added Pub. L. 106–65, div. A, title VII, §716(a)(1), Oct. 5, 1999, 113 Stat. 690; amended Pub. L. 112–81, div. A, title VII, §715, Dec. 31, 2011, 125 Stat. 1477.)
AMENDMENTS2011—Subsec. (a)(3). Pub. L. 112–81 added par. (3).
EFFECTIVE DATEPub. L. 106–65, div. A, title VII, §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 IMPLEMENTATIONPub. L. 106–65, div. A, title VII, §716(b), Oct. 5, 1999, 113 Stat. 691, directed the Secretary of Defense to submit to Congress a report assessing the effects of the implementation of the requirements and authorities set forth in this section not later than 6 months after Oct. 5, 1999.
Disclaimer: These codes may not be the most recent version. The United States Government Printing Office may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the US site. Please check official sources.