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.
Sponsored By: Representative McCormick, Richard [R-GA-7]
Introduced
Summary
This bill would shift TRICARE payments to a location-specific, lowest-rate reimbursement system. It would define five care-site categories and require location-identifying provider codes on claims, taking effect January 1, 2026.
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- Military families and beneficiaries: TRICARE payments for covered care would be tied to the actual care location using five site categories, not the provider's headquarters.
- Health care providers: Providers must include a unique, geographically specific national provider identifier on reimbursement claims and would be paid according to the site's designated rate.
- Department of Defense and TRICARE administrators: The Secretary would set separate reimbursement rates for inpatient hospitals, on-campus hospital outpatient departments, off-campus hospital outpatient departments, ambulatory surgical centers, and physician offices, and when multiple rates exist must pay the lowest authorized rate.
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Bill Overview
Analyzed Economic Effects
1 provisions identified: 0 benefits, 0 costs, 1 mixed.
TRICARE pay rates tied to care location
This bill would change how TRICARE pays doctors and hospitals. Rates would be set by where you get care: inpatient hospital, on-campus outpatient, off-campus outpatient, ambulatory surgery center, or a doctor’s office. If more than one rate could apply, TRICARE would pay the lowest allowed rate. Claims would need a location-specific provider ID code; the location is where care was given, not the provider’s headquarters. These rules would start January 1, 2026, and could mean some providers are paid less.
Sponsors & CoSponsors
Sponsor
McCormick, Richard [R-GA-7]
GA • R
Cosponsors
Crane
AZ • R
Sponsored 2/11/2025
Rep. Gosar, Paul A. [R-AZ-9]
AZ • R
Sponsored 6/25/2025
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov