- administering Secretaries
means the Secretaries of executive departments specified in section 1073 of this title as having responsibility for administering this chapter.
- career appointee
has the meaning given that term in section 3132(a)(4) of title 5.
- Civilian Health and Medical Program of the Uniformed Services
means the program authorized under sections 1079 and 1086 of this title and includes contracts entered into under section 1091 or 1097 of this title and demonstration projects under section 1092 of this title.
- clean claim
means a claim that has no defect, impropriety (including a lack of any required substantiating documentation), or particular circumstance requiring special treatment that prevents timely payment on the claim under this section.
- combat-related disability
has the meaning given that term in section 1413a of this title.
- conversion health policy
means a health insurance policy with a private insurer, developed through negotiations between the Secretary of Defense and the private insurer, that is available for purchase by or for the use of a person who is a dependent for a one-year period under section 1072(2)(H) of this title.
- core casualty receiving facility
means a Role 4 medical treatment facility that serves as a medical hub for the receipt and treatment of casualties, including civilian casualties, that may result from combat or from an event the President determines or declares as a natural disaster, mass casualty event, or other national emergency.
- covered beneficiary
means a beneficiary under this chapter other than a beneficiary under section 1074(a) of this title.
- covered disease or condition
means—
- covered facility
means a military medical treatment facility located outside the United States.
- covered member
means a member of the armed forces who is—
- covered payer
means a third-party payer or other insurance, medical service, or health plan.
- custodial care
means treatment or services, regardless of who recommends such treatment or services or where such treatment or services are provided, that—
- Defense Health Agency
means the Defense Agency established pursuant to Department of Defense Directive 5136.13, or such successor Defense Agency.
- delayed-effective-date active-duty order
means an order to active duty for a period of more than 30 days under section 12304b of this title or a provision of law referred to in section 101(a)(13)(B) of this title that provides for active-duty service to begin under such order on a date after the date of the issuance of the order.
- dental specialist
means an oral surgeon, orthodontist, prosthodontist, periodontist, endodontist, or pediatric dentist, and includes such other providers of dental care and services as determined appropriate by the Secretary of Defense.
- dependent
has the meaning given that term in section 551 of that title.
- disaster response duty
means duty performed by a member of the National Guard in State status pursuant to an emergency declaration by the Governor of the State (or, with respect to the District of Columbia, the mayor of the District of Columbia) in response to a disaster or in preparation for an imminent disaster.
- domiciliary care
means care provided to a patient in an institution or homelike environment because—
- drug unapproved for its applied use
means a drug administered for a use not described in the approved labeling of the drug under section 505 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355).
- eating disorder
has the meaning given the term “feeding and eating disorders” in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (or successor edition), published by the American Psychiatric Association.
- eligible beneficiary
means any beneficiary under this chapter.
- eligible child dependent
means a dependent described in subparagraph (D) or (I) of section 1072(2) of this title.
- eligible covered beneficiary
means a covered beneficiary for whom eligibility to receive pharmacy benefits through the means described in subsection (a)(2)(E) is established under this chapter or another provision of law.
- eligible dependent
means a dependent of a member of the uniformed services on active duty for a period of more than 30 days, as described in subparagraph (A), (D), or (I) of section 1072(2) of this title, who has a qualifying condition.
- employer
includes a State or unit of local government.
- fraud and abuse
means any conduct specified in subsection (a) or (b) of section 1128A of the Social Security Act (42 U.S.C. 1320a–7a).
- group health plan
means a group health plan (as that term is defined in section 5000(b)(1) of the Internal Revenue Code of 1986 without regard to section 5000(d) of the Internal Revenue Code of 1986).
- head of the agency concerned
means—
- health care
includes mental health care.
- health care provider
means any military or civilian health care professional who, under regulations of a military department, is granted clinical practice privileges to provide health care services in a military medical or dental treatment facility or who is licensed or certified to perform health care services by a governmental board or agency or professional health care society or organization.
- health care services
includes products provided or purchased through a facility of the uniformed services.
- health-care professional
means a physician, dentist, clinical psychologist, marriage and family therapist certified as such by a certification recognized by the Secretary of Defense, or nurse and any other person providing direct patient care as may be designated by the Secretary of Defense in regulations.
- hospice care
means the items and services described in section 1861(dd) of the Social Security Act (42 U.S.C. 1395x(dd)).
- immediate dependent
means a dependent described in subparagraph (A), (B), (C), or (D) of section 1072(2) of this title.
- independent health care contractor
means a health care provider who meets the following criteria:
- institution of higher education
means a four-year institution of higher education (as defined in section 101(a) of the Higher Education Act of 1965 (20 U.S.C. 1001(a))).
- insurance, medical service, or health plan
includes a preferred provider organization, an insurance plan described as Medicare supplemental insurance, and a personal injury protection plan or medical payments benefit plan for personal injuries resulting from the operation of a motor vehicle.
- investigational new drug
means a drug covered by section 505(i) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355(i)).
- least restrictive alternative principle
means a principle under which a member of the armed forces committed for hospitalization and treatment shall be placed in the most appropriate and therapeutic available setting—
- Medal of Honor recipient
means a person who has been awarded a medal of honor under section 7271, 8291, or 9271 of this title or section 2732 of title 14.
- medical quality assurance program
means any peer review activity carried out before, on, or after November 14, 1986 by or for the Department of Defense to assess the quality of medical care, including activities conducted by individuals, military medical or dental treatment facility committees, or other review bodies responsible for quality assurance, credentials, infection control, patient care assessment (including treatment procedures, blood, drugs, and therapeutics), medical records, health resources management review and identification and prevention of medical or dental incidents and risks.
- medical quality assurance record
means the proceedings, records, minutes, and reports that emanate from quality assurance program activities described in paragraph (1) and are produced or compiled by the Department of Defense as part of a medical quality assurance program.
- medicare
means title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).
- mental health evaluation
means a psychiatric examination or evaluation, a psychological examination or evaluation, an examination for psychiatric or psychological fitness for duty, or any other means of assessing the state of mental health of a member of the armed forces.
- mental health professional
means a psychiatrist or clinical psychologist, a person with a doctorate in clinical social work, or a psychiatric clinical nurse specialist.
- military medical treatment facility
means—
- National Disaster Medical System
means the system established under section 2812 of the Public Health Service Act (42 U.S.C. 300hh–11).
- necessary facilities
includes facilities that provide the services specified in section 1079(r)(1) of this title.
- network
means—
- non-standard option plan
means a high option dental insurance plan that includes covered services in addition to, or provides greater coverage with respect to, services covered under a standard option plan.
- out-of-network
means, with respect to health care services, such services provided by TRICARE-authorized civilian providers who have not entered into a contract under this chapter with a contractor under the TRICARE program.
- over-the-counter drug
means a drug that is not subject to section 503(b) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 353(b)).
- partner country
means any of the following:
- peer review
means any assessment of the quality of medical care carried out by a health care professional, including any such assessment of professional performance, any patient safety program root cause analysis or report, or any similar activity described in regulations prescribed by the Secretary under subsection (i).
- Persian Gulf veteran
means a member of the armed forces who served on active duty in the Southwest Asia theater of operations during the Persian Gulf Conflict.
- pharmaceutical agent
means drugs, biological products, and medical devices under the regulatory authority of the Food and Drug Administration.
- prescription drug
means a drug that is subject to section 503(b) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 353(b)).
- primary and preventive health care services for women
means health care services, including related counseling services, provided to women with respect to the following:
- prior consent requirement
means the requirement included in the relevant FDA regulations pursuant to section 505(i)(4) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355(i)(4)).
- Program
means the Military-Civilian Medical Surge Program established under paragraph (1).
- provider of services
means a hospital, skilled nursing facility, comprehensive outpatient rehabilitation facility, home health agency, hospice program (as defined in section 1861(dd)(2) of the Social Security Act (42 U.S.C. 1395x(dd)(2))), or other institutional facility providing services for which payment may be made under a plan covered by this section.
- qualifying condition
means the condition of a dependent who is moderately or severely mentally retarded, has a serious physical disability, or has an extraordinary physical or psychological condition.
- qualifying Persian Gulf symptom or illness
means, with respect to a member described in subsection (b), a symptom or illness—
- relevant FDA regulations
means the regulations promulgated under section 505(i) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355(i)).
- retired pay
includes retainer pay.
- Role 4 medical treatment facility
means a medical treatment facility that provides the full range of preventative, curative, acute, convalescent, restorative, and rehabilitative care.
- significant change
means a systemwide change—
- skilled nursing facility
has the meaning given such term in section 1819(a) of the Social Security Act (42 U.S.C. 1395i–3(a)).
- specialty care provider
includes a dental specialist.
- spell of illness
has the meaning given such term in section 1861(a) of such Act (42 U.S.C. 1395x(a)).
- standard option plan
means a dental insurance plan that provides for the coverage of preventive services, basic restorative services, and specialty dental care services at a level that is at least commensurate with the coverage of the same services provided under the premium sharing plans under this section during the period preceding January 1, 2027.
- State
means each of the several States, the District of Columbia, the Commonwealth of Puerto Rico, and any territory or possession of the United States.
- third party payer
has the meaning given such term in section 1095(h)(1) of this title.
- third-party payer
means an entity that provides an insurance, medical service, or health plan by contract or agreement, including an automobile liability insurance or no fault insurance carrier, and any other plan or program that is designed to provide compensation or coverage for expenses incurred by a beneficiary for health care services or products.
- uniformed services
means the armed forces and the Commissioned Corps of the National Oceanic and Atmospheric Administration and of the Public Health Service.