TRICARE PROGRAM LIMITATIONS ON PAYMENT RATES FOR INSTITUTIONAL HEALTH CARE PROVIDERS AND ON BALANCE BILLING BY INSTITUTIONAL AND NONINSTITUTIONAL HEALTH CARE PROVIDERS.

SEC. 707. TRICARE PROGRAM LIMITATIONS ON PAYMENT RATES FOR INSTITUTIONAL HEALTH CARE PROVIDERS AND ON BALANCE BILLING BY INSTITUTIONAL AND NONINSTITUTIONAL HEALTH CARE PROVIDERS. (a) Institutional Providers.—Section 1079(j) of title 10, United States Code, is amended— (1) in paragraph (2)(A)— (A) by striking “(A)”; and (B) by striking “may be determined under joint regulations” and inserting “shall be determined under joint regulations”; (2) by redesignating subparagraph (B) of paragraph (2) as paragraph (4), and, in such paragraph, as so redesignated, by striking “subparagraph (A),” and inserting “this subsection,”; and (3) by inserting before paragraph (4), as redesignated by paragraph (2), the following new paragraph (3): “(3) A contract for a plan covered by this section shall include a clause that prohibits each provider of services under the plan from billing any person covered by the plan for any balance of charges for services in excess of the amount paid for those services under the joint regulations referred to in paragraph (2), except for any unpaid amounts of deductibles or copayments that are payable directly to the provider by the person.”. (b) Noninstitutional Providers.—Section 1079(h)(4) of such title is amended— (1) by inserting “(A)” after “(4)”; and (2) by adding at the end the following new subparagraph: “(B) The regulations shall include a restriction that prohibits an individual health care professional (or other noninstitutional health care provider) from billing a beneficiary for services for more than the amount that is equal to— “(i) the excess of the limiting charge (as defined in section 1848(g)(2) of the Social Security Act (42 U.S.C. 1395w-4(g)(2))) that would be applicable if the services had been provided by the professional (or other provider) as an individual health care professional (or other noninstitutional health care provider) on a nonassignment-related basis under part B of title XVIII of such Act over the amount that is payable by the United States for those services under this subsection, plus 115 STAT. 1164 “(ii) any unpaid amounts of deductibles or copayments that are payable directly to the professional (or other provider) by the beneficiary.”. (c) Effective Date.—The amendments made by this section shall take effect on the date that is 90 days after the date of the enactment of this Act.