Sec. 742 — Improvement of process for filing of complaints and reporting of issues under TRICARE program

Statutory text

(a) In general. Not later than 180 days after the date of the enactment of this Act, the Secretary of Defense shall issue guidance to set forth the process and timeline for covered beneficiaries, direct care providers, and authorized providers under the TRICARE program to file complaints and report issues that have not been resolved through existing channels, including complaints regarding coverage, access to care, denials, incorrect provider directory listings, network adequacy, access to specialized care within a reasonable distance from their homes, overdue or consistently inaccurate payments, and other related issues.

(b) Elements of guidance. The guidance required under subsection (a) shall set forth—(1)the details and effective date of a reporting tool that follows a simple flow chart for filing complaints and reporting issues; and(2)the timelines and protocols that the Department of Defense will use to monitor and address complaints filed and issues reported that are appropriate to the level of acuity or urgency of such complaint or issue, including responses to the covered beneficiary or provider that include—(A)steps that have been taken by the Department of Defense to respond to the complaint or issue;(B)any responses received by relevant parties in investigating the complaint or issue; and(C)follow-up actions or planned follow-up actions by the Department of Defense in response to the complaint or issue.

(c) Application to providers. The guidance required under subsection (a) shall apply to all agreements with authorized providers under the TRICARE program entered into on or after the date of the enactment of this Act.

(d) Annual report. Not later than one year after the date of the enactment of this Act, and annually thereafter, the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report that includes the following:

(1) The number of complaints filed or issues reported that are covered by subsection (a), disaggregated by category of complaint or issue, beneficiary complaint or issue, or provider complaint or issue.

(2) A description of steps that were taken to respond to such complaints or issues.

(3) A description of any follow-up actions or planned follow-up actions by the Department of Defense in response to such complaints or issues.

(e) Definitions. In this section:

(1) The term covered Armed Force means the Army, Navy, Air Force, Marine Corps, and Space Force.

(2) The term covered beneficiary means a covered beneficiary, as defined in section 1072 of title 10, United States Code, who is a beneficiary by reason of the service by an individual in a covered Armed Force.

(3) The term TRICARE program has the meaning given that term in section 1072 of title 10, United States Code.