10 U.S.C. § 1100 — Defense Health Program Account

Page 1157 TITLE 10—ARMED FORCES § 1100 graphical 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 serv- ices. (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 pre- mium owed by a member, former member, or de- pendent under paragraph (1) shall be withheld from the retired, retainer, or equivalent pay of the member, former member, or dependent. In all other cases, a premium shall be paid in a fre- quency and method determined by the Sec- retary. (e) REGULATIONS.—The Secretary of Defense, after consultation with the other administering Secretaries, shall prescribe regulations to carry out this section. (Added Pub. L. 99–661, div. A, title VII, § 701(a)(1), Nov. 14, 1986, 100 Stat. 3896; amended Pub. L. 114–328, div. A, title VII, § 701(d)(1), (j)(1)(E), Dec. 23, 2016, 130 Stat. 2186, 2192; Pub. L. 116–92, div. A, title VII, § 702(a), (b)(2)(B), Dec. 20, 2019, 133 Stat. 1436.) Editorial Notes AMENDMENTS 2019—Pub. L. 116–92, § 702(b)(2)(B), inserted ‘‘and pay- ment options’’ after ‘‘system’’ in section catchline. Subsecs. (d), (e). Pub. L. 116–92, § 702(a), added subsec. (d) and redesignated former subsec. (d) as (e). 2016—Subsec. (b)(1). Pub. L. 114–328, § 701(d)(1), amend- ed par. (1) generally. Prior to amendment, text read as follows: ‘‘allow covered beneficiaries to elect a health care plan from eligible health care plans designated by the Secretary of Defense; or’’. Subsec. (c)(2). Pub. L. 114–328, § 701(j)(1)(E), added par. (2) and struck out former par. (2) which read as follows: ‘‘The Civilian Health and Medical Program of the Uni- formed Services.’’ Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 2019 AMENDMENT Amendment by Pub. L. 116–92 applicable to health care coverage beginning on or after Jan. 1, 2021, see sec- tion 702(c) of Pub. L. 116–92, set out as a note under sec- tion 1097a of this title. EFFECTIVE DATE OF 2016 AMENDMENT Amendment by Pub. L. 114–328 applicable with re- spect to the provision of health care under the TRICARE program beginning on Jan. 1, 2018, see sec- tion 701(k) of Pub. L. 114–328, set out as a note under section 1072 of this title. REGULATIONS Pub. L. 99–661, div. A, title VII, § 701(d)(1), (2), Nov. 14, 1986, 100 Stat. 3898, provided that: ‘‘(1) Except as provided in paragraph (2), the Sec- retary of Defense shall prescribe regulations as re- quired by section 1099(d) [now 1099(e)] of title 10, United States Code (as added by subsection (a)(1)) to imple- ment the system of health care enrollment for covered beneficiaries— ‘‘(A) on October 1, 1987, with respect to— ‘‘(i) covered beneficiaries included in the dem- onstration project required under section 702 [10 U.S.C. 1073 note]; and ‘‘(ii) facilities of the uniformed services located in the geographical area covered by the demonstration project; and ‘‘(B) not later than September 30, 1990, for all other covered beneficiaries and facilities of the uniformed services. ‘‘(2) The Secretary may not assign covered bene- ficiaries to facilities of the uniformed services, as au- thorized by section 1099(b)(2) of such title (as added by subsection (a)(1)), before October 1, 1990.’’ INITIAL ANNUAL OPEN ENROLLMENT PERIOD Pub. L. 114–328, div. A, title VII, § 701(d)(2), (3), Dec. 23, 2016, 130 Stat. 2186, provided that: ‘‘(2) APPLICATION.—The Secretary of Defense shall im- plement the initial annual open enrollment period pur- suant to section 1099(b)(1) of title 10, United States Code, as amended by paragraph (1), during 2018. ‘‘(3) GRACE PERIOD DURING FIRST YEAR.— ‘‘(A) At any time during the one-year period begin- ning on the date on which the initial annual open en- rollment period begins pursuant to section 1099(b)(1) of title 10, United States Code, as amended by para- graph (1), a covered beneficiary may make an elec- tion, or modify such an election, described in such section. ‘‘(B) If during such one-year period an individual who is eligible to enroll in the TRICARE program, but does not elect to enroll in such program, receives health care services for an episode of care that would be covered under the TRICARE program if such indi- vidual were enrolled in the TRICARE program, the Secretary— ‘‘(i) shall pay the out-of-network fees only for the first episode of care and inform the individual of the opportunity to enroll in the TRICARE program; and ‘‘(ii) may not pay any costs relating to any subse- quent episode of care if such individual is not en- rolled in the TRICARE program.’’ REPORTS TO CONGRESS Pub. L. 99–661, div. A, title VII, § 701(c)(1), Nov. 14, 1986, 100 Stat. 3898, required Secretary of Defense, not later than July 1, 1987, to submit to Congress a report detailing any plans to establish or implement a system of health care enrollment (other than as required under section 702(a)(2)(C)) under section 1099(a) of this title and the plan of the Secretary for completing implemen- tation of such system. § 1100. Defense Health Program Account (a) ESTABLISHMENT OF ACCOUNT.—(1) There is hereby established in the Department of Defense an account to be known as the ‘‘Defense Health Program Account’’. All sums appropriated to carry out the functions of the Secretary of De- fense with respect to medical and health care programs of the Department of Defense shall be appropriated to the account. (2) Of the total amount appropriated for a fis- cal year for programs and activities carried out under this chapter, the amount equal to three percent of such total amount shall remain avail- Page 1158 TITLE 10—ARMED FORCES § 1101 able for obligation until the end of the following fiscal year. (b) OBLIGATION OF AMOUNTS FROM ACCOUNT BY SECRETARY OF DEFENSE.—The Secretary of De- fense may obligate or expend funds from the ac- count for purposes of conducting programs and activities under this chapter, including con- tracts entered into under section 1079, 1086, 1092, or 1097 of this title, to the extent amounts are available in the account. (c) REGULATIONS.—The Secretary of Defense shall prescribe regulations to carry out this sec- tion. (Added Pub. L. 99–661, div. A, title VII, § 701(a)(1), Nov. 14, 1986, 100 Stat. 3896; amended Pub. L. 104–106, div. A, title VII, § 735(a)–(d)(1), Feb. 10, 1996, 110 Stat. 382.) Editorial Notes AMENDMENTS 1996—Pub. L. 104–106, § 735(d)(1), amended section catchline generally, substituting ‘‘Defense Health Pro- gram Account’’ for ‘‘Military Health Care Account’’. Subsec. (a)(1). Pub. L. 104–106, § 735(a)(1), substituted ‘‘Defense Health Program Account’’ for ‘‘Military Health Care Account’’ and ‘‘medical and health care programs of the Department of Defense’’ for ‘‘the Civil- ian Health and Medical Program of the Uniformed Services’’. Subsec. (a)(2). Pub. L. 104–106, § 735(b), amended par. (2) generally. Prior to amendment, par. (2) read as fol- lows: ‘‘Amounts appropriated to the account shall re- main available until obligated or expended under sub- section (b) or (c).’’ Subsec. (b). Pub. L. 104–106, § 735(a)(2), substituted ‘‘conducting programs and activities under this chap- ter, including contracts entered into’’ for ‘‘entering into a contract’’ and inserted comma after ‘‘title’’. Subsec. (c). Pub. L. 104–106, § 735(c), redesignated sub- sec. (e) as (c) and struck out former subsec. (c) which read as follows: ‘‘ALLOCATION OF AMOUNTS IN ACCOUNT FOR PROVISION OF MEDICAL CARE BY SERVICE SECRE- TARIES.—(1) The Secretary of a military department shall, before the beginning of a fiscal year quarter, pro- vide 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 depart- ment 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 quar- ter.’’ Subsec. (d). Pub. L. 104–106, § 735(c)(1), struck out sub- sec. (d) which read as follows: ‘‘EXPENDITURE OF AMOUNTS FROM ACCOUNT BY SERVICE SECRETARIES.—The Secretary of a military department shall provide med- ical 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 Sec- retary 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 ju- risdiction of the Secretary for the remainder of the fis- cal year quarter.’’ Subsec. (e). Pub. L. 104–106, § 735(c)(2), redesignated subsec. (e) as (c). Subsec. (f). Pub. L. 104–106, § 735(c)(1), struck out sub- sec. (f) which read as follows: ‘‘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.’’ Statutory Notes and Related Subsidiaries EFFECTIVE DATE Pub. L. 99–661, div. A, title VII, § 701(d)(3), Nov. 14, 1986, 100 Stat. 3898, provided that: ‘‘Section 1100 of such title (as added by subsection (a)(1)) shall take effect on October 1, 1987.’’ REPORTS TO CONGRESS Pub. L. 99–661, div. A, title VII, § 701(c)(2), Nov. 14, 1986, 100 Stat. 3898, required Secretary to submit to Congress not later than May 1, 1987, a report on plans of Secretary for establishing diagnosis-related groups for inpatient services under section 1100(a) of this title, and not later than May 1, 1988, a report on plans of Sec- retary for establishing diagnosis-related groups for out- patient services under such section. § 1101. Resource allocation methods: capitation or diagnosis-related groups (a) ESTABLISHMENT OF CAPITATION OR DRG METHOD.—The Secretary of Defense, after con- sultation with the other administering Secre- taries, shall establish by regulation the use of capitation or diagnosis-related groups as the primary criteria for allocation of resources to facilities of the uniformed services. (b) EXCEPTION FOR MOBILIZATION MISSIONS.— Capitation or 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 mo- bilization missions. (c) CONTENT OF REGULATIONS.—Such regula- tions may establish a system of diagnosis-re- lated 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 may include the following: (1) A classification of inpatient treatments by diagnosis-related groups and a similar clas- sification 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. (4) An appropriate method for calculating or estimating the annual per capita costs of pro- viding comprehensive health care services to members of the uniformed services on active duty and covered beneficiaries. (Added Pub. L. 99–661, div. A, title VII, § 701(a)(1), Nov. 14, 1986, 100 Stat. 3897; amended Pub. L. 100–456, div. A, title XII, § 1233(e)(1), Sept. 29, 1988, 102 Stat. 2057; Pub. L. 103–160, div. A, title VII, § 714(a), (b)(1), Nov. 30, 1993, 107 Stat. 1690.) Editorial Notes AMENDMENTS 1993—Pub. L. 103–160, § 714(b)(1), substituted ‘‘Re- source allocation methods: capitation or diagnosis-re- lated groups’’ for ‘‘Diagnosis-related groups’’ as section catchline.