LegisTrack
Back to all bills
HR 873119th CongressIn Committee

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.

Introduced: Jan 31, 2025
Standard Summary
Comprehensive overview in 1-2 paragraphs

This bill would change how TRICARE reimburses care and services by tying payment rates to where the care is provided, rather than to where the provider is located or other factors. Specifically, it requires that the Department of Defense set location-specific reimbursement rates for TRICARE payments at several defined care settings (inpatient hospital, on-campus and off-campus hospital outpatient departments, ambulatory surgical centers, and physician offices). When multiple rates could apply for a given service, the Secretary would pay the lowest applicable rate. It would also require claims to include a unique, geographically specific national provider identifier (NPI) code identifying the service location. The changes would take effect January 1, 2026. In practical terms, the bill shifts TRICARE payment toward a location-based framework and enforces standardized geographic coding on claims. This could affect how much providers are paid for TRICARE-covered care, potentially lowering payments in some cases and changing how care sites are chosen or billed. The requirement to code the service location on claims would also increase administrative detail for TRICARE providers.

Key Points

  • 1The bill amends 10 U.S.C. § 1097b(a) to implement location-based TRICARE reimbursement rates and to select the lowest applicable rate when multiple rates exist.
  • 2Reimbursement rates would be specific to five defined locations where care is provided: inpatient hospital, on-campus hospital outpatient department, off-campus hospital outpatient department, ambulatory surgical center, and the office of a physician (rates tied to where care is delivered, not the provider’s headquarters).
  • 3The Secretary must ensure that TRICARE claims include a unique, geographically specific national provider identifier (NPI) code that identifies the care location as described in the bill.
  • 4The effective date for these changes is January 1, 2026.
  • 5The bill explicitly changes how TRICARE pays for care and introduces location-based payment logic within the TRICARE program.

Impact Areas

Primary group/area affected- TRICARE beneficiaries (including active-duty service members, retirees, and their families) who receive care under TRICARE, as well as TRICARE network providers who bill for services.Secondary group/area affected- TRICARE contracting and network administrators within the Department of Defense, who would implement and administer the new location-based rates and the geographically specific NPI requirements.Additional impacts- Health care providers may experience changes in reimbursement patterns, potentially affecting provider participation, practice location decisions, and billing practices.- Potential effects on access and distribution of care, particularly if lower location-based rates influence where care is sought or offered (e.g., hospitals vs. physician offices).- Administrative changes and costs associated with implementing location-specific rate coding and the new geographic NPI requirements on billing systems.
Generated by gpt-5-nano on Nov 18, 2025