Overview

Title

To direct the Secretary of Defense to carry out a pilot program under which a TRICARE Prime beneficiary may access obstetrical and gynecological care without a referral, and for other purposes.

ELI5 AI

The bill wants to try out a new program that lets certain people using the military's health plan, called TRICARE Prime, see a special doctor for women's health care without needing to get permission first, like a pass to see the doctor faster. They want to see how this works for five years and learn if it's helpful or not.

Summary AI

H. R. 10307, also known as the “TRICARE OBGYN Treatment and Access without Lags in Care Act” or the “TOTAL Care Act,” proposes a pilot program directed by the Secretary of Defense. The program allows TRICARE Prime beneficiaries to access obstetrical and gynecological care without needing a referral. Participants can choose to have an OBGYN provider as an additional primary care manager. This pilot will run for five years, and the Secretary must report on the program's impact within four years of its start.

Published

2024-12-05
Congress: 118
Session: 2
Chamber: HOUSE
Status: Introduced in House
Date: 2024-12-05
Package ID: BILLS-118hr10307ih

Keywords AI

tricare prime obstetrical care gynecological care referral-free access pilot program department of defense healthcare access female beneficiaries primary care management healthcare policy

Sources

Bill Statistics

Size

Sections:
2
Words:
524
Pages:
3
Sentences:
13

Language

Nouns: 164
Verbs: 35
Adjectives: 35
Adverbs: 3
Numbers: 21
Entities: 40

Complexity

Average Token Length:
4.40
Average Sentence Length:
40.31
Token Entropy:
4.72
Readability (ARI):
23.05

AnalysisAI

The bill titled "TRICARE OBGYN Treatment and Access without Lags in Care Act," also known as the "TOTAL Care Act," aims to implement a significant change to the TRICARE Prime program, which provides health benefits for military personnel and their families. The proposed legislation seeks to establish a five-year pilot program allowing beneficiaries to access obstetrical and gynecological care without needing a referral. This initiative, starting within 180 days of the bill’s enactment, also enables covered female participants to select a specialized care provider as an additional primary care manager under the TRICARE program.

General Summary

The total Care Act proposes a pilot program targeting TRICARE Prime beneficiaries, primarily focusing on female members who require obstetrical and gynecological services. By removing the referral requirement and allowing for a specialized care provider to be designated, the bill aims to streamline access to necessary medical services and potentially improve the quality of personal healthcare management for participants. After four years of the program, a report is mandated to assess various outcomes such as changes in enrollment and associated costs of care.

Summary of Significant Issues

Several significant issues are highlighted in the bill:

  1. Funding Ambiguity: The bill lacks clarity concerning the financing of the pilot program. Without a specific designated budget or funding source, there could be challenges in effective implementation and resource allocation.

  2. Eligibility and Coverage: The term "covered participants" might lead to confusion because it is not clearly defined. More precise eligibility criteria could help forestall disputes regarding who can partake in the program.

  3. Integration and Continuity of Care: While the bill allows for obstetrical and gynecological providers to become designated primary care managers, it does not define how this will function within existing healthcare structures. This absence of detail could affect the quality and continuity of care.

  4. Metrics for Assessing Costs: There is no specific framework provided for evaluating changes in care costs. Lack of clear metrics could result in inconclusive findings about the financial impact of the pilot program.

  5. Effectiveness Measurement: The lack of detailed benchmarks or objectives may hinder a comprehensive evaluation, which is crucial for refining and possibly expanding the program.

Public Impact

The implementation of this bill could have substantial implications for the public, particularly for active military personnel and their families relying on TRICARE Prime. By reducing the administrative hurdle of referrals, beneficiaries might experience quicker access to essential healthcare services, potentially leading to better health outcomes. However, if not adequately funded and structured, the pilot program might face operational hindrances, affecting service delivery.

Stakeholder Impact

Positive Impacts:

  • Beneficiaries: Female beneficiaries could benefit from improved access and reduced wait times for obtaining necessary healthcare services.

  • Healthcare Providers: Obstetrical and gynecological healthcare providers might see an increase in patient interaction and can build more direct relationships with TRICARE Prime beneficiaries.

Negative Impacts:

  • Administrative Systems: Current healthcare management systems may face challenges integrating the new designation allowance for primary care managers, possibly resulting in disruptions in care coordination.

  • Financial Planning and Resource Allocation: Without clear budget provisions, there could be an unsustainable strain on available resources or inefficient use of funds, impacting resource allocation.

In conclusion, while the proposed TOTAL Care Act primarily aims to enhance access to care for female TRICARE Prime enrollees, the lack of clarity regarding funding, eligibility criteria, and integration of new practices into existing systems presents challenges that need addressing. If these issues are resolved, the bill could significantly improve healthcare experiences for a segment of TRICARE's beneficiaries.

Issues

  • The bill (Section 2(a)) lacks specificity in funding for the pilot program, potentially leading to financial uncertainties regarding its implementation.

  • The criteria for 'covered participants' in the pilot program (Section 2(d)(2)) are vague, potentially leading to disputes or inconsistencies in interpreting eligibility for the pilot program.

  • There is no clear framework in the bill (Section 2(a)(2)) about how the integration of an obstetrical or gynecological care provider as a primary care manager will work with current systems, raising concerns about continuity and quality of care.

  • The bill (Section 2(c)(2)) does not specify the metrics or data points for assessing changes in costs, which could result in ambiguous or non-comprehensive evaluations of the pilot program's financial impact.

  • There is a lack of clarity in how the effectiveness of the pilot program will be measured (Section 2(c)), with only general references to enrollment changes, potentially affecting the program's assessment and future adjustments.

Sections

Sections are presented as they are annotated in the original legislative text. Any missing headers, numbers, or non-consecutive order is due to the original text.

1. Short title Read Opens in new tab

Summary AI

The first section of the bill provides its short title, which is the "TRICARE OBGYN Treatment and Access without Lags in Care Act" or the "TOTAL Care Act".

2. Pilot program on access to obstetrical and gynecological care under TRICARE Prime program Read Opens in new tab

Summary AI

The section establishes a five-year pilot program in which certain rules for obstetrical and gynecological care under the TRICARE Prime program are changed. Specifically, covered participants, who are female beneficiaries, do not need a referral for this type of care and can choose an additional primary care manager specializing in obstetrics or gynecology.