§ 1097. Contracts for medical care for retirees, dependents, and survivors: alternative delivery of health care

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. 1986

   Department of Defense Authorization Act, 1987

   Pub. L. 99–661 div. A title VII § 701(a)(1) · 100 Stat. 3816

   Enacted · 10 U.S.C. § 1097

   Added Pub. L. 99–661, div. A, title VII, § 701(a)(1), Nov. 14, 1986, 100 Stat. 3895

   Source evidence

   Code source credit
   Added Pub. L. 99–661, div. A, title VII, § 701(a)(1), Nov. 14, 1986, 100 Stat. 3895

   Enacted provision · exact public law section
   (1) Chapter 55 of title 10, United States Code, is amended by adding at the end the following new sections: “§ 1096. Military-civilian health services partnership program “(a) Resources Sharing Agreements.— The Secretary of Defense may enter into an agreement providing for the sharing of resources between facilities of the uniformed services and facilities of a civilian health care provider or providers that the Secretary contracts 10 USC 1079, 1086, 1097. with under section 1079, 1086, or 1097 of this title if the Secretary determines that such an agreement would result in the delivery of health care to which covered beneficiaries are entitled under this chapter in a more effective, efficient, or economical manner. “(b) Eligible Resources.— An agreement entered into under subsection (a) may provide for the sharing of— “(1) personnel (including support personnel); “(2) equipment; “(3) supplies; and “(4) any other items or facilities necessary for the provision of health care services. “(c) Computation of Charges.— A covered beneficiary, with respect to care provided to such beneficiary in facilities of the uniformed services under a sharing agreement entered into under subsection (a), shall pay— “(1) in the case of a dependent, the charges prescribed by section 1078 of this title; and 10 USC 1078. “(2) in the case of a member or former member entitled to retired or retainer pay, the charges prescribed by section 1075 of this title. 10 USC 1075. “§ 1097. Contracts for medical care for retirees, dependents, and survivors: alternative delivery of health care “(a) In General.— The Secretary of Defense, after consulting with the other administering Secretaries, may contract for the delivery of health care to which covered beneficiaries are entitled under this chapter. The Secretary may enter into a contract under this section with any of the following: “(1) Health maintenance organizations. “(2) Preferred provider organizations. “(3) Individual providers, individual medical facilities, or insurers. “(4) Consortiums of such providers, facilities, or insurers. “(b) Scope of Coverage Under Health Care Plans.— A contract entered into under this section may provide for the delivery of— “(1) selected health care services; “(2) total health care services for selected covered beneficiaries; or “(3) total health care services for all covered beneficiaries who reside in a geographical area designated by the Secretary. “(c) Charges for Health Care.— The Secretary of Defense may prescribe by regulation a premium, deductible, copayment, or other charge for health care provided under this section. “§ 1098. Incentives for participation in cost-effective health care plans “(a) Waiver of Limitations and Copayments.— Subject to subsections Contracts. (b) and (c), the Secretary of Defense, with respect to any plan contracted for under the authority of section 1079 or 1086 of this title, may waive, in whole or in part— 10 USC 1079, 1086. “(1) any limitation set out in the second sentence of section 1079(a) of this title; or “(2) any requirement for payment by the patient under section 1079(b) or 1086(b) of this title. “(b) Determination and Report.— (1) Subject to paragraph (3), the Secretary may waive a limitation or requirement as authorized by subsection (a) if the Secretary determines that during the period of the waiver such a plan will— “(A) be less costly to the Government than a plan subject to such limitations or payment requirements; or “(B) provide better services than those provided by a plan subject to such limitations or payment requirements at no additional cost to the Government. “(2) The Secretary shall submit to the Committees on Armed Reports. Services of the Senate and House of Representatives a report with respect to a waiver under paragraph (1), including a comparison of costs of and benefits available under— “(A) a plan with respect to which the limitations and payment requirements are waived; and “(B) a plan with respect to which there is no such waiver “(3) A waiver under paragraph (1) may not take effect until the end of the 180-day period beginning on the date on which the Secretary submits the report required by paragraph (2) with respect to such waiver. “§ 1099. Health care enrollment system “(a) Establishment of System.— The Secretary of Defense, after consultation with the other administering Secretaries, shall establish a system of health care enrollment for covered beneficiaries who reside in the United States. “(b) Description of System.— Such system shall— “(1) allow covered beneficiaries to elect a health care plan from eligible health care plans designated by the Secretary of Defense; or “(2) if necessary in order to ensure full use of facilities of the uniformed services in a geographical area, assign covered beneficiaries who reside in such area to such facilities. “(c) Health Care Plans Available Under System.— A health care plan designated by the Secretary of Defense under the system described in subsection (a) shall provide all health care to which a covered beneficiary is entitled under this chapter. Such a plan may consist of any of the following: “(1) Use of facilities of the uniformed services. “(2) The Civilian Health and Medical Program of the Uniformed Services. “(3) Contracts. Any other health care plan contracted for by the Secretary of Defense. “(4) Any combination of the plans described in paragraphs (1), (2), and (3). “(d) Regulations.— The Secretary of Defense, after consultation with the other administering Secretaries, shall prescribe regulations to carry out this section. “§ 1100. Military Health Care Account “(a) Establishment of Account.— (1) There is hereby established in the Department of Defense an account to be known as the ‘Military Health Care Account’. All sums appropriated to carry out the functions of the Secretary of Defense with respect to the Civilian Health and Medical Program of the Uniformed Services shall be appropriated to the account. “(2) Amounts appropriated to the account shall remain available until obligated or expended under subsection (b) or (c). “(b) Contracts. Obligation of Amounts From Account by Secretary of Defense.— The Secretary of Defense may obligate or expend funds from the account for purposes of entering into a contract under 10 USC 1079, 1086, 1092; ante, p. 3895. section 1079, 1086, 1092, or 1097 of this title to the extent amounts are available in the account. “(c) Allocation of Amounts in Account for Provision of Medical Care by Service Secretaries.— (1) The Secretary of a military department shall, before the beginning of a fiscal year quarter, provide to the Secretary of Defense an estimate of the amounts necessary to pay for charges for benefits under the program for covered beneficiaries under the jurisdiction of the Secretary for that quarter. “(2) The Secretary of Defense shall, subject to amounts provided in advance in appropriation Acts, make available to each Secretary of a military department the amount from the account that the Secretary of Defense determines is necessary to pay for charges for benefits under the program for covered beneficiaries under the jurisdiction of such Secretary for that quarter. “(d) Expenditure of Amounts From Account by Service Secretaries.— The Secretary of a military department shall provide medical and dental care to covered beneficiaries under the jurisdiction of the Secretary for a fiscal year quarter from amounts appropriated to the Secretary and from amounts from the account made available for that quarter to the Secretary by the Secretary of Defense. If the Secretary of a military department exhausts the amounts from the account made available to the Secretary for a fiscal year quarter, the Secretary shall transfer to the account from amounts appropriated to the Secretary an amount sufficient to provide medical and dental care to covered beneficiaries under the jurisdiction of the Secretary for the remainder of the fiscal year quarter. “(e) Regulations.— The Secretary of Defense shall prescribe regulations to carry out this section. “(f) Definitions.— In this section: “(1) The term ‘account’ means the Military Health Care Account established in subsection (a). “(2) The term ‘program’ means the Civilian Health and Medical Program of the Uniformed Services. “§ 1101. Diagnosis-related groups “(a) Establishment of DRGs.— The Secretary of Defense, after consultation with the other administering Secretaries, shall establish by regulation the use of diagnosis-related groups as the primary criteria for allocation of resources to facilities of the uniformed services. “(b) Exception for Mobilization Missions.— Diagnosis-related groups shall not be used to allocate resources to the facilities of the uniformed services to the extent that such resources are required by such facilities for mobilization missions. “(c) Content of Regulations.— (1) Such regulations shall establish a system of diagnosis-related groups similar to the system established under section 1886(d)(4) of the Social Security Act (42 U.S.C. 1395ww(d)(4)). Such regulations shall include the following: “(1) A classification of inpatient treatments by diagnosis-related groups and a similar classification of outpatient treatment. “(2) A methodology for classifying specific treatments within such groups. “(3) An appropriate weighting factor for each such diagnosis-related group which reflects the relative resources used by a facility of a uniformed service with respect to treatments classified within that group compared to treatments classified within other groups.”.

2. 1994

   National Defense Authorization Act for Fiscal Year 1995

   Pub. L. 103–337 § 714(a)(2) · 108 Stat. 2663

   Redesignated · 10 U.S.C. § 1097(c)

   Pub. L. 103–337, § 714(a)(2), added subsec. (c). Former subsec. (c) redesignated (e)

   Source evidence

   Code amendment note
   Subsec. (c). Pub. L. 103–337, § 714(a)(2), added subsec. (c). Former subsec. (c) redesignated (e).

   Enacted provision · exact public law section
   (2) by inserting after subsection (b) the following new subsections: “(c) Coordination With Facilities of the Uniformed Services.— The Secretary of Defense may provide for the coordination of health care services provided pursuant to any contract or agreement under this section with those services provided in medical treatment facilities of the uniformed services. Subject to the availability of space and facilities and the capabilities of the medical or dental staff, the Secretary may not deny access to facilities of the uniformed services to a covered beneficiary on the basis of whether the beneficiary enrolled or declined enrollment in any program established under, or operating in connection with, any contract under this section. However, the Secretary may, as an incentive for enrollment, establish reasonable preferences for services in facilities of the uniformed services for covered beneficiaries enrolled in any program established under, or operating in connection with, any contract under this section. “(d) Coordination With Other Health Care Programs.— In the case of a covered beneficiary who is enrolled in a managed health care program not operated under the authority of this chapter, the Secretary may contract under this section with such other managed health care program for the purpose of coordinating the beneficiary’s dual entitlements under such program and this chapter. A managed health care program with which arrangements may be made under this subsection includes any health maintenance organization, competitive medical plan, health care prepayment plan, or other managed care program recognized pursuant to regulations issued by the Secretary.”.

3. 1994

   National Defense Authorization Act for Fiscal Year 1995

   Pub. L. 103–337 § 713 · 108 Stat. 2663

   Inserted · 10 U.S.C. § 1097(c)

   Pub. L. 103–337, § 713, inserted at end “In the case of contracts for health care services under this section or health care plans offered under section 1099 of this title for which the Secretary permits covered beneficiaries who are covered by section 1086 of this title and who participate in such contracts or plans to pay an enrollment fee in lieu of meeting the applicable deductible amount specified in section 1086(b) of this title, the Secretary may establish the same (or a lower) enrollment fee for covered beneficiaries described in section 1086(d)(1) of this title who also participate in such contracts or plans.”

   Target inherited from the preceding amendment note.

   Source evidence

   Code amendment note
   Pub. L. 103–337, § 713, inserted at end “In the case of contracts for health care services under this section or health care plans offered under section 1099 of this title for which the Secretary permits covered beneficiaries who are covered by section 1086 of this title and who participate in such contracts or plans to pay an enrollment fee in lieu of meeting the applicable deductible amount specified in section 1086(b) of this title, the Secretary may establish the same (or a lower) enrollment fee for covered beneficiaries described in section 1086(d)(1) of this title who also participate in such contracts or plans.”

   Enacted provision · exact public law section
   SEC. 713. IMPOSITION OF ENROLLMENT FEES FOR MANAGED CARE PLANS. Section 1097(c) of title 10, United States Code, is amended by adding at the end the following new sentence: “In the case of contracts for health care services under this section or health care plans offered under section 1099 of this title for which the Secretary permits covered beneficiaries who are covered by section 1086 of this title and who participate in such contracts or plans to pay an enrollment fee in lieu of meeting the applicable deductible amount specified in section 1086(b) of this title, the Secretary may establish the same (or a lower) enrollment fee for covered beneficiaries described in section 1086(d)(1) of this title who also participate in such contracts or plans.”.

4. 1994

   National Defense Authorization Act for Fiscal Year 1995

   Pub. L. 103–337 § 714(a) · 108 Stat. 2663

   1. Added · 10 U.S.C. § 1097(d); 10 U.S.C. § 1097(e)

      Pub. L. 103–337, § 714(a), added subsec. (d)

   2. Redesignated · 10 U.S.C. § 1097(d); 10 U.S.C. § 1097(e)

      Pub. L. 103–337, § 714(a), redesignated former subsec. (c) as (e)

   Source evidence

   Code amendment note
   Subsecs. (d), (e). Pub. L. 103–337, § 714(a), added subsec. (d) and redesignated former subsec. (c) as (e).

   Enacted provision · exact public law section
   (a) Amendments to Alternative Health Care Delivery Contracts Authority.— Section 1097 of title 10, United States Code, is amended— (1) by redesignating subsection (c) (as amended by section 713) as subsection (e); and (2) by inserting after subsection (b) the following new subsections: “(c) Coordination With Facilities of the Uniformed Services.— The Secretary of Defense may provide for the coordination of health care services provided pursuant to any contract or agreement under this section with those services provided in medical treatment facilities of the uniformed services. Subject to the availability of space and facilities and the capabilities of the medical or dental staff, the Secretary may not deny access to facilities of the uniformed services to a covered beneficiary on the basis of whether the beneficiary enrolled or declined enrollment in any program established under, or operating in connection with, any contract under this section. However, the Secretary may, as an incentive for enrollment, establish reasonable preferences for services in facilities of the uniformed services for covered beneficiaries enrolled in any program established under, or operating in connection with, any contract under this section. “(d) Coordination With Other Health Care Programs.— In the case of a covered beneficiary who is enrolled in a managed health care program not operated under the authority of this chapter, the Secretary may contract under this section with such other managed health care program for the purpose of coordinating the beneficiary’s dual entitlements under such program and this chapter. A managed health care program with which arrangements may be made under this subsection includes any health maintenance organization, competitive medical plan, health care prepayment plan, or other managed care program recognized pursuant to regulations issued by the Secretary.”.

5. 1996

   National Defense Authorization Act for Fiscal Year 1996

   Pub. L. 104–106 § 712 · 110 Stat. 186

   Substituted · 10 U.S.C. § 1097(c)

   Pub. L. 104–106, § 712, substituted “Notwithstanding the preferences established by sections 1074(b) and 1076 of this title, the Secretary shall” for “However, the Secretary may”

   Source evidence

   Code amendment note
   Subsec. (c). Pub. L. 104–106, § 712, substituted “Notwithstanding the preferences established by sections 1074(b) and 1076 of this title, the Secretary shall” for “However, the Secretary may”.

   Enacted provision · exact public law section
   SEC. 712. PRIORITY USE OF MILITARY TREATMENT FACILITIES FOR PERSONS ENROLLED IN MANAGED CARE INITIATIVES. Section 1097(c) of title 10, United States Code, is amended in the third sentence by striking out “However, the Secretary may” and inserting in lieu thereof “Notwithstanding the preferences established by sections 1074(b) and 1076 of this title, the Secretary shall”.

6. 1996

   National Defense Authorization Act for Fiscal Year 1996

   Pub. L. 104–106 § 713 · 110 Stat. 186

   Inserted · 10 U.S.C. § 1097(e)

   Pub. L. 104–106, § 713, inserted at end “Without imposing additional costs on covered beneficiaries who participate in contracts for health care services under this section or health care plans offered under section 1099 of this title, the Secretary shall permit such covered beneficiaries to pay, on a quarterly basis, any enrollment fee required for such participation.”

   Source evidence

   Code amendment note
   Subsec. (e). Pub. L. 104–106, § 713, inserted at end “Without imposing additional costs on covered beneficiaries who participate in contracts for health care services under this section or health care plans offered under section 1099 of this title, the Secretary shall permit such covered beneficiaries to pay, on a quarterly basis, any enrollment fee required for such participation.”

   Enacted provision · exact public law section
   SEC. 713. STAGGERED PAYMENT OF ENROLLMENT FEES FOR TRICARE PROGRAM. Section 1097(e) of title 10, United States Code, is amended by adding at the end the following new sentence: “Without imposing additional costs on covered beneficiaries who participate in contracts for health care services under this section or health care plans offered under section 1099 of this title, the Secretary shall permit such covered beneficiaries to pay, on a quarterly basis, any enrollment fee required for such participation.”.

7. 2006

   John Warner National Defense Authorization Act for Fiscal Year 2007

   Pub. L. 109–364 div. A title VII § 704(a) · 120 Stat. 2083

   Inserted · 10 U.S.C. § 1097(e)

   Pub. L. 109–364 inserted at end “A premium, deductible, copayment, or other charge prescribed by the Secretary under this subsection may not be increased during the period beginning on April 1, 2006, and ending on September 30, 2007.”

   Source evidence

   Code amendment note
   Subsec. (e). Pub. L. 109–364 inserted at end “A premium, deductible, copayment, or other charge prescribed by the Secretary under this subsection may not be increased during the period beginning on April 1, 2006, and ending on September 30, 2007.”

   Enacted provision · exact public law section
   (a) Prohibition on Increase in Charges Under Contracts for Medical Care.— Section 1097(e) of title 10, United States Code, is amended by adding at the end the following: “A premium, deductible, copayment, or other charge prescribed by the Secretary under this subsection may not be increased during the period beginning on April 1, 2006, and ending on September 30, 2007.”.

8. 2008

   National Defense Authorization Act for Fiscal Year 2008

   Pub. L. 110–181 div. A title VII § 701(a) · 122 Stat. 3

   Substituted · 10 U.S.C. § 1097(e)

   Pub. L. 110–181 substituted “September 30, 2008” for “September 30, 2007”

   Target inherited from the preceding amendment note.

   Source evidence

   Code amendment note
   Pub. L. 110–181 substituted “September 30, 2008” for “September 30, 2007”.

   Enacted provision · exact public law section
   (a) Charges Under Contracts for Medical Care.— Section 1097(e) of title 10, United States Code, is amended by striking “September 30, 2007” and inserting “September 30, 2008”.

9. 2008

   Duncan Hunter National Defense Authorization Act for Fiscal Year 2009

   Pub. L. 110–417 · 122 Stat. 4356

   Substituted · 10 U.S.C. § 1097(e)

   Pub. L. 110–417 substituted “September 30, 2009” for “September 30, 2008”

   Source evidence

   Code amendment note
   Subsec. (e). Pub. L. 110–417 substituted “September 30, 2009” for “September 30, 2008”.

10. 2011

    Ike Skelton National Defense Authorization Act for Fiscal Year 2011

    Pub. L. 111–383 div. A title VII § 701(a) · 124 Stat. 4137

    Substituted · 10 U.S.C. § 1097(e)

    Pub. L. 111–383 substituted “September 30, 2011” for “September 30, 2009”

    Source evidence

    Code amendment note
    Subsec. (e). Pub. L. 111–383 substituted “September 30, 2011” for “September 30, 2009”.

    Enacted provision · exact public law section
    (a) Charges Under Contracts for Medical Care.— Section 1097(e) of title 10, United States Code, is amended by striking “September 30, 2009” and inserting “September 30, 2011”.

11. 2011

    National Defense Authorization Act for Fiscal Year 2012

    Pub. L. 112–81 div. A title VII § 701(a) · 125 Stat. 1298

    1. Amended · 10 U.S.C. § 1097(e)

       Pub. L. 112–81 designated existing provisions as par. (1)

    2. Substituted · 10 U.S.C. § 1097(e)

       Pub. L. 112–81 substituted “Except as provided by paragraph (2), a premium,” for “A premium,”

    3. Added · 10 U.S.C. § 1097(e)

       Pub. L. 112–81 added par. (2)

    Source evidence

    Code amendment note
    Subsec. (e). Pub. L. 112–81 designated existing provisions as par. (1), substituted “Except as provided by paragraph (2), a premium,” for “A premium,”, and added par. (2).

    Enacted provision · exact public law section
    (a) Annual Enrollment Fees.— Section 1097(e) of title 10, United States Code, is amended— (1) by striking “The Secretary of Defense” and inserting “(1) The Secretary of Defense”; (2) by striking “A premium,” and inserting “Except as provided by paragraph (2), a premium,”; and (3) by adding at the end the following new paragraph: “(2) Beginning October 1, 2012, the Secretary of Defense may only increase in any year the annual enrollment fees described in paragraph (1) by an amount equal to the percentage by which retired pay is increased under section 1401a of this title.” .

13 of 14 references resolved to an enrolled provision · 1 partial