§1079b — Title 10 Armed Forces | U.S. Code

Summary

Military hospitals must have rules that let them charge civilians who are not eligible for military health benefits (or their insurers) for the cost of trauma and other medical care. The Defense Health Agency director may waive a fee if the care helps train or improve military health staff. If a civilian has insurance (a “covered payer”) when treated, the person only pays the normal copays, coinsurance, deductibles, or small fees from their plan. The Department of Defense may bill the insurer only, and payment from that insurer is full payment. If a civilian is uninsured, underinsured, or faces financial harm, the director must cut fees using a sliding discount and must provide a catastrophic waiver to avoid severe harm. Only the DoD can run that payment program. Amounts collected may be kept and used for trauma consortium work, running and equipping facilities, and readiness training. Definitions: covered payer — an insurance or health plan that pays for care; third-party payer/insurance terms — defined in section 1095(h).

Title 10, §1079b

Armed Forces — Source: USLM XML via OLRC

(a)The Secretary of Defense shall implement procedures under which a military medical treatment facility may charge civilians who are not covered beneficiaries (or their insurers) fees representing the costs, as determined by the Secretary, of trauma and other medical care provided to such civilians.

(b)The Director of the Defense Health Agency may issue a waiver for a fee that would otherwise be charged under the procedures implemented under subsection (a) to a civilian provided medical care who is not a covered beneficiary if the provision of such care enhances the knowledge, skills, and abilities of health care providers, as determined by the Director of the Defense Health Agency.

(c)(1)(A)If a civilian specified in subsection (a) is covered by a covered payer at the time care under this section is provided, the civilian shall only be responsible to pay the standard copays, coinsurance, deductibles, or nominal fees that are otherwise applicable under the covered payer plan.

(B)Except with respect to the copays, coinsurance, deductibles, and nominal fees specified in subparagraph (A)—

(i)the Secretary of Defense may bill only the covered payer for care provided to a civilian described in subparagraph (A); and

(ii)payment received by the Secretary from the covered payer of a civilian for care provided under this section that is provided to the civilian shall be considered payment in full for such care.

(2)If a civilian specified in subsection (a) does not meet the criteria under paragraph (1), is underinsured, or has a remaining balance and is at risk of financial harm, the Director of the Defense Health Agency shall reduce each fee that would otherwise be charged to the civilian under this section according to a sliding fee discount program, as prescribed by the Director of the Defense Health Agency.

(3)If a civilian specified in subsection (a) does not meet the criteria under paragraph (1) or (2), the Director of the Defense Health Agency shall implement an additional catastrophic waiver to prevent severe financial harm.

(4)The modified payment plan under this subsection may not be administered by a Federal agency other than the Department of Defense.

(d)A military medical treatment facility may retain and use the amounts collected under subsection (a) for—

(1)trauma consortium activities;

(2)administrative, operating, and equipment costs; and

(3)readiness training.

(e)In this section:

(1)The term “covered payer” means a third-party payer or other insurance, medical service, or health plan.

(2)The terms “third-party payer” and “insurance, medical service, or health plan” have the meaning given those terms in section 1095(h) of this title.

Notes & Related Subsidiaries

Editorial Notes

Amendments

2022—Subsec. (b). Pub. L. 117–263, § 716(a)(1), amended subsec. (b) generally. Prior to amendment, text read as follows: “The Secretary may waive a fee that would otherwise be charged under the procedures implemented under subsection (a) to a civilian who is not a covered beneficiary if— “(1) the civilian is unable to pay for the costs of the trauma or other medical care provided to the civilian (including any such costs remaining after the Secretary receives payment from an insurer for such care, as applicable); and “(2) the provision of such care enhances the knowledge, skills, and abilities of health care providers, as determined by the Secretary.” Subsecs. (c), (d). Pub. L. 117–263, § 716(a)(2), (b)(1), added subsec. (c) and redesignated former subsec. (c) as (d). Subsec. (e). Pub. L. 117–263, § 716(b)(2), added subsec. (e). 2021—Subsecs. (b), (c). Pub. L. 116–283 added subsec. (b) and redesignated former subsec. (b) as (c).

Statutory Notes and Related Subsidiaries

Effective Date

of 2022 Amendment Pub. L. 117–263, div. A, title VII, § 716(c), Dec. 23, 2022, 136 Stat. 2661, provided that: “The

Amendments

made by subsections (a) and (b) [amending this section] shall apply with respect to care provided on or after the date that is 180 days after the date of the enactment of this Act [Dec. 23, 2022].” Improved Implementation of Financial Relief for Civilians Treated in Military Medical Treatment Facilities Pub. L. 118–159, div. A, title VII, § 717, Dec. 23, 2024, 138 Stat. 1949, provided that: “(a) Final Rule Required.—The Secretary of Defense shall issue a final rule (or interim final rule) to implement as soon as possible after the date of the enactment of this Act [Dec. 23, 2024] section 1079b of title 10, United States Code. “(b) Treatment of Claims.—“(1) In general.—Except as provided in paragraph (2), the Secretary shall hold in abeyance any claims under section 1079b of title 10, United States Code, until the final rule (or interim final rule) required under subsection (a) is in effect. “(2) Exception.—Paragraph (1) does not apply to—“(A) claims to third-party payers; or “(B) administrative support provided to the Secretary by another Federal agency to assist the Secretary in the administration of section 1079b of title 10, United States Code.” Deadline for Implementation Pub. L. 107–107, div. A, title VII, § 732(b), Dec. 28, 2001, 115 Stat. 1170, directed the Secretary of Defense to begin to implement the procedures required by subsec. (a) of this section not later than one year after Dec. 28, 2001.

§1079b Procedures for charging fees for care provided to civilians; retention and use of fees collected

Summary

Title 10, §1079b

Notes & Related Subsidiaries

Editorial Notes

Amendments

Statutory Notes and Related Subsidiaries

Effective Date

Amendments

Citations & Metadata