The TOTAL Care Act would require the Secretary of Defense to run a five-year pilot program under TRICARE Prime that lets female beneficiaries access obstetrical and gynecological (OB/GYN) care without the standard referral. Participants could also choose to designate an OB/GYN as an additional designated primary care manager (PCM) under TRICARE. The program must start within 180 days of enactment. A review report is due to the congressional defense committees no later than four years after enactment, evaluating things like TRICARE Prime enrollment trends and the costs of OB/GYN care under the pilot. In effect, the bill tests whether removing the referral bottleneck for OB/GYN services improves access and potentially affects costs and enrollment.
Key Points
- 1The referral requirement for OB/GYN care in TRICARE Prime would not apply to covered participants in the pilot, including related OB/GYN items and services.
- 2Participants may designate an OB/GYN as an additional designated primary care manager under TRICARE.
- 3The pilot runs for five years, with implementation required within 180 days of enactment.
- 4A report to the congressional defense committees is due no later than four years after enactment, addressing enrollment changes, costs, and other relevant matters.
- 5Definitions provided include: “covered participant” (a female TRICARE Prime beneficiary who elects to participate) and clarifications of TRICARE Prime and related terms.