PRIA, Government Policy, Made Personal

Summary

The Secretary of Defense must set up rules so military hospitals can charge civilians who are not covered beneficiaries (or their insurers) for the cost of trauma and other medical care, as the Secretary decides. The Director of the Defense Health Agency can waive a fee if the care improves the skills or knowledge of health care providers. If the civilian has a covered payer at the time of care, the civilian only pays the usual copays, coinsurance, deductibles, or small fees under that plan, and the Department may bill only the payer; payment from the payer is full payment. For underinsured people or those at risk of financial harm, the Director must lower fees using a sliding discount and must have a separate catastrophic waiver to avoid severe financial harm. Only the Department of Defense may run this payment plan. A military hospital may keep the money it collects and use it for trauma consortium activities, administrative and operating costs, equipment, and readiness training. “Covered payer” means a third‑party payer or other insurance, medical service, or health plan. Other related terms use the meanings in section 1095(h) of this title.

Title 10, §1079b

Armed Forces, Source: USLM XML via OLRC

(a)Requirement To Implement Procedures.—

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)Waiver of Fees.—

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)Modified Payment Plan for Certain Civilians.—

(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)Use of Fees Collected.—

A military medical treatment facility may retain and use the amounts collected under subsection (a) for— (1)

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

(3)readiness training.

(e)Definitions.—

In this section: (1)

(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