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10 U.S.C. § 1097 — Contracts for medical care for retirees, dependents, and survivors: alternative delivery of health care
Federal law — U.S. Code and appendices · legal_authorities
**(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) 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. Notwithstanding the preferences established by sections 1074(b) and 1076 of this title, the Secretary shall, as an incentive for enrollment, establish reasonable preferences for services in facilities of the uniformed services for covered beneficiari
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Source file: Laws/federal/codes/united-states-code/title-10/section-1097-contracts-for-medical-care-for-retirees-dependents-and-survivors-alterna--e7d48441c2.md
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Source location: Title 10, Chapter 55, § 1097; chapter-055-medical-and-dental-care.md
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**(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) 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. Notwithstanding the preferences established by sections 1074(b) and 1076 of this title, the Secretary shall, 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.
**(e) Charges for Health Care.—**
(1) The Secretary of Defense may prescribe by regulation a premium, deductible, copayment, or other charge for health care provided under this section. In the case of contracts for health care services under this section or health care plans offered under [section 1099 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1099&num=0&edition=prelim) for which the Secretary permits covered beneficiaries who are covered by [section 1086 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1086&num=0&edition=prelim) 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](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1086/b&num=0&edition=prelim), the Secretary may establish the same (or a lower) enrollment fee for covered beneficiaries described in [section 1086(d)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1086/d/1&num=0&edition=prelim) who also participate in such contracts or plans. 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](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1099&num=0&edition=prelim), the Secretary shall permit such covered beneficiaries to pay, on a quarterly basis, any enrollment fee required for such participation. Except as provided by paragraph (2), 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, 2011.
(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](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1401a&num=0&edition=prelim).
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Federal law — U.S. Code and appendices · legal_authorities
**(a)** To assure that health benefits are available for the persons covered by subsection (c), the Secretary of Defense, after consulting with the other administering Secretaries, shall contract under the authority of this section for health benefits for those persons under the same insurance, medical service, or health plans he contracts for under [section 1079(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1079/a&num=0&edition=prelim). However, eye examinations and (except as provided in subsection (i)) treatments for eating disorders may not be provided under such plans for persons covered by subsection (c).
**(b)** For persons covered by this section the plans contracted for under [section 1079(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section1079/a&num=0&edition=prelim) shall contain the following provisions for payment by the patient:
(1) Except as provided in paragraph (2), the first $150 each calendar year of the charges for all types of care authorized by this section and received while in an outpatient status and 25 percent of all subsequent charges for such care during a calendar year.
(2) A family group of two or more persons covered by this section shall not be required to pay collectively more than the first $300 each calendar year of the charges for all types of care authorized by this section and received while in an outpatient status and 25 percent of the additional charges for such care during a calendar year.
(3) 25 percent of the charges for inpatient care, except that in no case may the charges for inpatient care for a patient exceed $535 per day during the period beginning on April 1, 2006, and ending on September 30, 2011. The Secretary of Defense may
Source: Supplied U.S. Code snapshot — release unconfirmed · 10 U.S.C. § 1086
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Prohibition on Recomputation To Reflect Increases in Basic Pay.—** Unless otherwise specifically provided by law, the retired pay of a member or former member of an armed force may not be recomputed to reflect any increase in the rates of basic pay for members of the armed forces.
**(b) Cost-of-Living Adjustments Based on CPI Increases.—**
(1) **Increase required.—** — Effective on December 1 of each year, the Secretary of Defense shall increase the retired pay of members and former members entitled to that pay in accordance with paragraphs (2) and (3).
(2) **Percentage increase.—** — Except as otherwise provided in this subsection, the Secretary shall increase the retired pay of each member and former member by the percent (adjusted to the nearest one-tenth of 1 percent) by which—
(A) the price index for the base quarter of that year, exceeds
(B) the base index.
(3) **Reduced percentage for certain post-august 1, 1986 members.—** — If the percent determined under paragraph (2) is greater than 1 percent, the Secretary shall increase the retired pay of each member and former member who first became a member on or after August 1, 1986, and has elected to receive a bonus under section 322 (as in effect before the enactment of the National Defense Authorization Act for Fiscal Year 2008) or [section 354 of title 37](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title37-section354&num=0&edition=prelim), by the difference between—
(A) the percent determined under paragraph (2); and
(B) 1 percent.
(4) **Special rule for paragraph (3).—** — If in any case in which an increase in retired pay that would otherwise be made under paragraph (3) is not made by reason of law (other than any provision of this section), then (unless otherwise provided
Source: Supplied U.S. Code snapshot — release unconfirmed · 10 U.S.C. § 1401a
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Federal law — U.S. Code and appendices · legal_authorities
**(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 to enroll in a health care plan, or modify a previous election, from eligible health care plans designated by the Secretary of Defense during—
(A) an annual open enrollment period; and
(B) any period based on a qualifying event experienced by the beneficiary, as determined appropriate by the Secretary; 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) A plan under the TRICARE program.
(3) 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) Payment Options.—**
(1) A member or former member of the uniformed services, or a dependent thereof, eligible for medical care and dental care under section 1074(b) or 1076 of this title shall pay a premium for coverage under this chapter.
(2) To the maximum extent practicable, a premium owed by a member, former member, or dependent under paragraph (1) shall be withheld from the retired, retainer, or equivalent pay of the membe
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Federal law — U.S. Code and appendices · legal_authorities
In this chapter:
(1) The term “uniformed services” means the armed forces and the Commissioned Corps of the National Oceanic and Atmospheric Administration and of the Public Health Service.
(2) The term “dependent”, with respect to a member or former member of a uniformed service, means—
(A) the spouse;
(B) the unremarried widow;
(C) the unremarried widower;
(D) a child who—
(i) has not attained the age of 21;
(ii) has not attained the age of 23, is enrolled in a full-time course of study at an institution of higher learning approved by the administering Secretary and is, or was at the time of the member’s or former member’s death, in fact dependent on the member or former member for over one-half of the child’s support; or
(iii) is incapable of self-support because of a mental or physical incapacity that occurs while a dependent of a member or former member under clause (i) or (ii) and is, or was at the time of the member’s or former member’s death, in fact dependent on the member or former member for over one-half of the child’s support;
(E) a parent or parent-in-law who is, or was at the time of the member’s or former member’s death, in fact dependent on him for over one-half of his support and residing in his household;
(F) the unremarried former spouse of a member or former member who (i) on the date of the final decree of divorce, dissolution, or annulment, had been married to the member or former member for a period of at least 20 years during which period the member or former member performed at least 20 years of service which is creditable in determining that member’s or former member’s eligibility for retired or retainer pay, or equivalent pay, and (ii) does not have medical coverage under an employer-sponsored health plan;
Source: Supplied U.S. Code snapshot — release unconfirmed · 10 U.S.C. § 1072
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Responsible Officials.—**
(1) Except as otherwise provided in this chapter, the Secretary of Defense shall administer this chapter for the armed forces under his jurisdiction, the Secretary of Homeland Security shall administer this chapter for the Coast Guard when the Coast Guard is not operating as a service in the Navy, and the Secretary of Health and Human Services shall administer this chapter for the National Oceanic and Atmospheric Administration and the Public Health Service. This chapter shall be administered consistent with the Assisted Suicide Funding Restriction Act of 1997 ([42 U.S.C. 14401](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section14401&num=0&edition=prelim) et seq.).
(2) Except as otherwise provided in this chapter, the Secretary of Defense shall have responsibility for administering the TRICARE program and making any decision affecting such program.
**(b) Stability in Program of Benefits.—** The Secretary of Defense shall, to the maximum extent practicable, provide a stable program of benefits under this chapter throughout each fiscal year. To achieve the stability in the case of managed care support contracts entered into under this chapter, the contracts shall be administered so as to implement all changes in benefits and administration on a quarterly basis. However, the Secretary of Defense may implement any such change prior to the next fiscal quarter if the Secretary determines that the change would significantly improve the provision of care to eligible beneficiaries under this chapter.
Source: Supplied U.S. Code snapshot — release unconfirmed · 10 U.S.C. § 1073
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Federal law — U.S. Code and appendices · legal_authorities
Page 1151
TITLE 10—ARMED FORCES
§ 1097
‘‘(B) urgent care; and
‘‘(C) through telehealth appointments, when ap-
propriate;
‘‘(7) encourage patients to participate in making
health care decisions;
‘‘(8) use evidence-based treatment protocols that
improve the consistency of health care and eliminate
ineffective, wasteful health care practices; and
‘‘(9) improve coordination of behavioral health
services with primary health care.
‘‘(c) AGREEMENTS.—
‘‘(1) IN GENERAL.—In establishing military-civilian
integrated health delivery systems through partner-
ships under subsection (a), the Secretary shall seek
to enter into memoranda of understanding or con-
tracts between military treatment facilities and
health maintenance organizations, health care cen-
ters of excellence, public or private academic medical
institutions, regional health organizations, inte-
grated health systems, accountable care organiza-
tions, and such other health systems as the Secretary
considers appropriate.
‘‘(2) PRIVATE SECTOR CARE.—Memoranda of under-
standing and contracts entered into under paragraph
(1) shall ensure that covered beneficiaries are eligible
to enroll in and receive medical services under the
private sector components of military-civilian inte-
grated health delivery systems established under sub-
section (a).
‘‘(3)
VALUE-BASED
REIMBURSEMENT
METHODOLO-
GIES.—The Secretary shall incorporate value-based
reimbursement methodologies, such as capitated pay-
ments, bundled payments, or pay for performance,
into memoranda of understanding and contracts en-
tered into under paragraph (1) to reimburse entities
for medical services provided to covered beneficiaries
under such memoranda of understanding and con-
tracts.
‘‘(4) QUALITY OF CARE.—Each memorandum of un-
derstan
Source: Supplied 2024 U.S. Code historical extraction · 10 U.S.C. § 1097
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