Page:United States Statutes at Large Volume 110 Part 1.djvu/404

 110 STAT. 380 PUBLIC LAW 104-106—FEB. 10, 1996 (C) result in an enrolled population dissimilar to the general beneficiary population. (2) The Comptroller General shall not be required to prepare or submit the evaluation under paragraph (1) if the Uniformed Services Treatment Facilities fail to satisfactorily comply with subsection (b), as determined by the Comptroller General. SEC. 727. ELIMINATION OF UNNECESSARY ANNUAL REPORTING REQUIREMENT REGARDING UNIFORMED SERVICES TREATMENT FACILITIES. Section 1252 of the Department of Defense Authorization Act, 1984 (42 U.S.C. 248d), is amended by striking out subsection (d). Subtitle D—Other Changes to Existing Laws Regarding Health Care Management Regulations. SEC. 731. MAXIMUM ALLOWABLE PAYMENTS TO INDIVIDUAL HEALTH- CARE PROVIDERS UNDER CHAMPUS. (a) MAXIMUM PAYMENT.— Subsection (h) of section 1079 of title 10, United States Code, is amended by striking out paragraph (1) and inserting in lieu thereof the following new paragraph: "(1) Payment for a charge for services by an individual health care professional (or other noninstitutional health care provider) for which a claim is submitted under a plan contracted for under subsection (a) may not exceed the lesser of— "(A) the amount equivalent to the 80th percentile of billed charges made for similar services in the same locality during the base period; or "(B) an amount determined to be appropriate, to the extent practicable, in accordance with the same reimbursement rules as apply to pa3anents for similar services under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).". (b) COMPARISON TO MEDICARE PAYMENTS.— Such subsection is further amended by adding at the end the following new paragraph: "(3) For the purposes of paragraph (1)(B), the appropriate pay- ment amount shall be determined by the Secretary of Defense, in consultation with the other administering Secretaries.". (c) EXCEPTIONS AND LIMITATIONS. —Such subsection is further amended by inserting after paragraph (3), as added by subsection (b), the following new paragraphs: "(4) The Secretary of Defense, in consultation with the other administering Secretaries, shall prescribe regulations to provide for such exceptions to the payment limitations under paragraph (1) as the Secretary determines to be necessary to assure that covered beneficiaries retain adequate access to health care services. Such exceptions may include the payment of amounts higher than the amount allowed under paragraph (1) when enrollees in managed care programs obtain covered emergency services from nonparticipating providers. To provide a suitable transition from the payment methodologies in effect before the date of the enactment of this paragraph to the methodology required by paragraph (1), the amount allowable for any service may not be reduced by more than 15 percent below the amount allowed for the same service during the immediately preceding 12-month period (or other period as established by the Secretary of Defense).

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