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.
- Bill Number
- H.R. 873
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Armed Forces and National Security
- Status
- Introduced
- Latest Action
- 2025-01-31: Referred to the House Committee on Armed Services.
- Last Updated
- 2025-06-26T08:06:39Z
AI-Generated Summary
Purpose
This bill (H.R. 873) aims to update how the Department of Defense (DoD) reimburses healthcare providers under the TRICARE program—the health insurance for active-duty service members, retirees, and their families—by tying payment rates to the exact location where medical care or services are delivered. The goal is to ensure lower reimbursement rates are used when possible, potentially reducing overall program costs.
Key Provisions
- Lowest Rate Requirement: When multiple reimbursement rates are available for the same care or services under TRICARE, the Secretary of Defense must select and pay the lowest authorized rate, except in cases specified elsewhere in the law.
- Location-Specific Reimbursement Rates: The Secretary must set distinct payment rates based on the service location (regardless of the provider's main office location), including:
- Inpatient hospital (overnight stays).
- On-campus hospital outpatient department (outpatient care at the main hospital site).
- Off-campus hospital outpatient department (outpatient care at a separate site).
- Ambulatory surgical center (facility for same-day surgeries).
- Physician's office (doctor's clinic or practice).
- Claim Requirements: All reimbursement claims must include a unique national provider identifier (NPI) code that precisely identifies the service location geographically.
- Effective Date: Changes take effect on January 1, 2026.
Significant Changes to Existing Law
- Amends Section 1097b(a) of Title 10, U.S. Code, which previously allowed more flexibility in setting TRICARE rates without mandating the lowest rate or requiring location-specific distinctions.
- Adds new subparagraphs emphasizing lowest-rate selection and detailed location-based rate structures, shifting from broader rate-setting authority to more prescriptive, cost-controlling rules.
- Introduces mandatory use of geographically specific NPI codes on claims, which was not explicitly required before.
Potential Impacts
- On Government Agencies: The DoD and TRICARE program could see reduced healthcare spending by enforcing lower rates and precise location tracking, potentially saving taxpayer funds allocated to military health benefits.
- On Citizens: TRICARE beneficiaries (military personnel and families) may indirectly benefit from cost controls that help sustain the program's long-term affordability, though it could affect provider availability if payments drop too low.
- On International Relations: Minimal direct impact, as TRICARE primarily serves U.S.-based military communities; however, it might influence overseas providers if location rules extend to international sites.
Main Stakeholders Affected
- Department of Defense and TRICARE Administrators: Responsible for implementing new rate structures and claim verification processes.
- Healthcare Providers: Hospitals, outpatient departments, surgical centers, and physicians who bill TRICARE; they may receive lower payments based on service location, potentially affecting revenue and participation in the program.
- Military Beneficiaries: Service members, veterans, and families relying on TRICARE for affordable care, who could experience changes in provider networks or out-of-pocket costs if providers adjust services.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens federal oversight of healthcare reimbursements under Title 10, ensuring compliance with cost-efficiency mandates, but may lead to disputes over rate calculations or NPI code enforcement through administrative reviews or lawsuits by providers.
- Constitutional: No apparent challenges; aligns with Congress's authority to regulate military benefits and spending under Article I, Section 8.
- Political: Represents a bipartisan effort to control federal healthcare costs amid rising military budgets; could spark debate between cost-saving advocates and healthcare industry groups concerned about reduced provider incentives, especially if it influences broader defense appropriations.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. McCormick, Richard [R-GA-7]
Cosponsors (2)
Rep. Crane, Elijah [R-AZ-2], Rep. Gosar, Paul A. [R-AZ-9]
Recent Actions
- 2025-01-31: Referred to the House Committee on Armed Services.
- 2025-01-31: Introduced in House
- 2025-01-31: Introduced in House
Bill Versions
- 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. — issued 2025-01-31 — PDF (3 pages)