H.R.873 - 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. (119th Congress)
Summary
H.R. 873 aims to amend Title 10 of the United States Code, specifically targeting the TRICARE program's reimbursement rates. The bill proposes to modify how healthcare providers are paid based on the location where care or services are delivered. This includes differentiating rates for inpatient hospitals, on-campus and off-campus outpatient departments, ambulatory surgical centers, and physician offices.
Expected Effects
The primary effect of this bill, if enacted, would be a restructuring of TRICARE reimbursement rates. Healthcare providers may see changes in their payments depending on the setting in which they provide care. This could influence where providers choose to offer services and potentially affect patient access.
Potential Benefits
- Potential cost savings for the TRICARE program by paying the lowest authorized rate when multiple rates are possible.
- Increased transparency in healthcare pricing by requiring geographically specific national provider identifier codes.
- May incentivize more efficient use of healthcare resources by aligning reimbursement with the cost of providing care in different settings.
- Could lead to a more standardized and predictable payment system for healthcare providers.
- Potentially reduces fraud and abuse by clarifying reimbursement rates based on location.
Most Benefited Areas:
Potential Disadvantages
- Potential for reduced access to care if providers in certain locations (e.g., off-campus outpatient departments) reduce services due to lower reimbursement rates.
- Increased administrative burden for healthcare providers to comply with new coding and billing requirements.
- Possible negative impact on the quality of care if providers are incentivized to cut costs to maintain profitability.
- May disproportionately affect smaller or rural healthcare providers who may have higher overhead costs.
- Potential for unintended consequences if the lowest rate authorized is not sufficient to cover the cost of providing quality care.
Constitutional Alignment
The bill appears to align with the Constitution's general welfare clause (Preamble). Congress has the power to legislate for the common defense, which includes providing healthcare to military personnel and their families through programs like TRICARE. The bill does not appear to infringe on any specific constitutional rights or limitations.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).