PLANS FOR MEDICARE SUBVENTION DEMONSTRATION Reports. PROGRAMS.

SEC. 713. PLANS FOR MEDICARE SUBVENTION DEMONSTRATION Reports. PROGRAMS. (a) Program for Enrollment in TRICARE Managed Care Option.— Not later than September 6, 1996, the Secretary of Defense and the Secretary of Health and Human Services shall jointly submit to Congress and the President a report containing a specific plan (including the recommendations of the Secretaries required under subsection (b)) regarding the establishment of a demonstration program under which— (1) covered beneficiaries under chapter 55 of title 10, United States Code, who are also entitled to benefits under part A of the medicare program are permitted to enroll in the managed care option of the TRICARE program; and (2) the Secretary of Health and Human Services reimburses the Secretary of Defense from the Medicare program on a capitated basis for the costs of providing health care services to military retirees who enroll. (b) Specific Elements of Report.— The report shall include the following: (1) The number of covered beneficiaries described in subsection (a) who are projected to participate in the demonstration program and the minimum number of such participants necessary to conduct the demonstration program effectively. (2) A plan for notifying such covered beneficiaries of their eligibility for enrollment in the demonstration program and for any other matters connected with enrollment. (3) A recommendation for the duration of the demonstration program. (4) A recommendation for the geographic regions in which the demonstration program should be conducted. (5) The appropriate level of capitated reimbursement, and a schedule for such reimbursement, from the Medicare program 110 STAT. 2592to the Department of Defense for health care services provided enrollees in the demonstration program. (6) An estimate of the amounts that, in the absence of the demonstration program, would be required to be allocated by the Department of Defense for the provision of health care services to covered beneficiaries described in subsection (a) who reside in the regions in which the demonstration program is proposed to be conducted. (7) An assessment of revisions to the allocation estimated under paragraph (6) that would result from the conduct of the demonstration program in such regions. (8) An estimate of the cost to the Department of Defense and to the Medicare program of providing health care services to covered beneficiaries described in subsection (a) who enroll in the demonstration program. (9) An assessment of the likelihood of cost shifting among the Department of Defense and the Medicare program under the demonstration program. (10) A proposal for mechanisms for reconciling and reimbursing any improper payments among the Department of Defense and the Medicare program under the demonstration program. (11) A methodology for evaluating the demonstration program, including cost analyses. (12) As assessment of the extent to which the TRICARE program is prepared to meet requirements of the Medicare program for purposes of the demonstration program and the provisions of law or regulation that would have to be waived in order to facilitate the carrying out of the demonstration program. (13) An assessment of the impact of the demonstration program on military readiness. (14) Contingency plans for the provision of health care services under the demonstration program in the event of the mobilization of health care personnel. (15) A recommendation of the reports that the Department of Defense and the Department of Health and Human Services should submit to Congress describing the conduct of the demonstration program. (c) Program for Enrollment in TRICARE Fee-For-Service Option.— Not later than January 3, 1997, the Secretary of Defense and the Secretary of Health and Human Services shall jointly submit to Congress and the President a report on the feasibility and advisability of expanding the demonstration program referred to in subsection (a) so as to provide the Department of Defense with reimbursement from the Medicare program on a fee-for-service basis for health care services provided covered beneficiaries described in subsection (a) who enroll in the demonstration program. The report shall include a proposal for the expansion of the program if the expansion is determined to be advisable.