§ 1095f. TRICARE program: referrals and preauthorizations under TRICARE Prime

Legislative history

Reconstructed from this section’s Code source credit and amendment notes, resolved against the local Statutes at Large. Editorial notes are evidence, not the law that made the change.

1. 2000

   Pub. L. 106–398 § 1(dA) · 114 Stat. 1654

   Enacted · 10 U.S.C. § 1095f

   Added Pub. L. 106–398, § 1 [[div. A], title VII, § 728(a)(1)], Oct. 30, 2000, 114 Stat. 1654, 1654A–189

   Source evidence

   Code source credit
   Added Pub. L. 106–398, § 1 [[div. A], title VII, § 728(a)(1)], Oct. 30, 2000, 114 Stat. 1654, 1654A–189

   Enacted provision · exact public law section
   SECTION 1. ENACTMENT OF FISCAL YEAR 2001 NATIONAL DEFENSE AUTHORIZATION ACT. The provisions of H.R. 5408 of the 106th Congress, as introduced on October 6, 2000, are hereby enacted into law.

2. 2016

   National Defense Authorization Act for Fiscal Year 2017

   Pub. L. 114–328 div. A title VII § 701(c) · 130 Stat. 2000

   Amended · 10 U.S.C. § 1095f

   Pub. L. 114–328 amended section generally. Prior to amendment, text read as follows: “The Secretary of Defense shall ensure that no contract for managed care support under the TRICARE program includes any requirement that a managed care support contractor require a primary care or specialty care provider to obtain prior authorization before referring a patient to a specialty care provider that is part of the network of health care providers or institutions of the contractor.”

   Source evidence

   Code amendment note
   Pub. L. 114–328 amended section generally. Prior to amendment, text read as follows: “The Secretary of Defense shall ensure that no contract for managed care support under the TRICARE program includes any requirement that a managed care support contractor require a primary care or specialty care provider to obtain prior authorization before referring a patient to a specialty care provider that is part of the network of health care providers or institutions of the contractor.”

   Enacted provision · exact public law section
   (c) Referrals and Preauthorization for TRICARE Prime.— Section 1095f of title 10, United States Code, is amended to read as follows: “§ 1095f. TRICARE program: referrals and preauthorizations under TRICARE Prime “(a) Referrals.— (1) Except as provided by paragraph (2), a beneficiary enrolled in TRICARE Prime shall be required to obtain a referral for care through a designated primary care manager (or other care coordinator) prior to obtaining care under the TRICARE program. “(2) The Secretary may waive the referral requirement in paragraph (1) in such circumstances as the Secretary may establish for purposes of this subsection. “(3) The cost-sharing amounts for a beneficiary enrolled in TRICARE Prime who does not obtain a referral for care under paragraph (1) (or a waiver pursuant to paragraph (2) for such care) shall be determined under section 1075a(c) of this title. “(b) Preauthorization.— A beneficiary enrolled in TRICARE Prime shall be required to obtain preauthorization only with respect to a referral for the following: “(1) Inpatient hospitalization. “(2) Inpatient care at a skilled nursing facility. “(3) Inpatient care at a rehabilitation facility. “(c) Prohibition Regarding Prior Authorization for Certain Referrals.— The Secretary of Defense shall ensure that no contract for managed care support under the TRICARE program includes any requirement that a managed care support contractor require a primary care or specialty care provider to obtain prior authorization before referring a patient to a specialty care provider that is part of the network of health care providers or institutions of the contractor.” .

   Effective date note
   Amendment by Pub. L. 114–328 applicable with respect to the provision of health care under the TRICARE program beginning on Jan. 1, 2018, see section 701(k) of Pub. L. 114–328, set out as a note under section 1072 of this title.

3. 2017

   National Defense Authorization Act for Fiscal Year 2018

   Pub. L. 115–91 div. A title VII § 739(e)(1) · 131 Stat. 1283

   Added · 10 U.S.C. § 1095f(b)(4)

   Pub. L. 115–91 added par. (4)

   Source evidence

   Code amendment note
   Subsec. (b)(4). Pub. L. 115–91 added par. (4).

   Enacted provision · exact public law section
   (1) Preauthorization for care at residential treatment centers.— Section 1095f(b) of such title is amended by adding at the end the following new paragraph: “(4) Inpatient care at a residential treatment center.” .

4. 2024

   Pub. L. 118–159 div. A title VII § 703 · 138 Stat. 1942

   1. Amended · 10 U.S.C. § 1095f(a)(2)

      Pub. L. 118–159 designated existing provisions as subpar. (A)

   2. Added · 10 U.S.C. § 1095f(a)(2)

      Pub. L. 118–159 added subpar. (B)

   Unresolved: Pub. L. 118–159 was not found in the local Statutes at Large index.

   Source evidence

   Code amendment note
   Subsec. (a)(2). Pub. L. 118–159 designated existing provisions as subpar. (A) and added subpar. (B).

3 of 5 references resolved to an enrolled provision · 2 unresolved