(a)
(2) The Secretary may waive the referral requirement in paragraph (1) in such circumstances as the Secretary may establish for purposes of this subsection.
(3) The cost-sharing amounts for a beneficiary enrolled in TRICARE Prime who does not obtain a referral for care under paragraph (1) (or a waiver pursuant to paragraph (2) for such care) shall be determined under section 1075a(c) of this title.
(b)
(1) Inpatient hospitalization.
(2) Inpatient care at a skilled nursing facility.
(3) Inpatient care at a rehabilitation facility.
(4) Inpatient care at a residential treatment center.
(c)
Amendments
2017—Subsec. (b)(4). Pub. L. 115–91 added par. (4).
2016—Pub. L. 114–328 amended section generally. Prior to amendment, text read as follows: "The Secretary of Defense shall ensure that no contract for managed care support under the TRICARE program includes any requirement that a managed care support contractor require a primary care or specialty care provider to obtain prior authorization before referring a patient to a specialty care provider that is part of the network of health care providers or institutions of the contractor."
Effective Date of 2016 Amendment
Amendment by Pub. L. 114–328 applicable with respect to the provision of health care under the TRICARE program beginning on Jan. 1, 2018, see section 701(k) of Pub. L. 114–328, set out as a note under section 1072 of this title.
Effective Date
Pub. L. 106–398, §1 [[div. A], title VII, §728(c)], Oct. 30, 2000, 114 Stat. 1654, 1654A–189, provided that: "Section 1095f of title 10, United States Code, as added by subsection (a), shall apply with respect to a TRICARE managed care support contract entered into by the Department of Defense after the date of the enactment of this Act [Oct. 30, 2000]."
Streamlining of TRICARE Prime Beneficiary Referral Process
Pub. L. 115–232, div. A, title VII, §714, Aug. 13, 2018, 132 Stat. 1812, provided that:
"(a)
"(b)
"(1) The referral process shall model best industry practices for referrals from primary care managers to specialty care providers.
"(2) The process shall limit administrative requirements for enrolled beneficiaries.
"(3) Beneficiary preferences for communications relating to appointment referrals using state-of-the-art information technology shall be used to expedite the process.
"(4) There shall be effective and efficient processes to determine the availability of appointments at military medical treatment facilities and, when unavailable, to make prompt referrals to network providers under the TRICARE program.
"(c)
"(d)
"(1) evaluate the referral process described in subsection (a) not less often than annually; and
"(2) make appropriate improvements to the process in light of such evaluations.
"(e)