H.R. 873: To amend title 10, United States Code, to modify the rate of pay for care or services provided under the TRICARE program based on the location at which such care or services were provided.

This bill seeks to revise the reimbursement structure for healthcare providers under the TRICARE program, which is the health care program for military personnel and their families. The main changes proposed in the bill include:

Revisions to TRICARE Reimbursement Rates

• The bill amends the current regulations to specify how reimbursement rates should be determined based on the location where care or services are provided.
• When reimbursing healthcare providers, if the Secretary of Defense has a choice of more than one reimbursement rate, they will pay the lowest authorized rate for the specific care or services rendered.
• Reimbursement rates must be established specifically for various types of healthcare facilities, including:
  • Inpatient hospitals
  • On-campus hospital outpatient departments
  • Off-campus hospital outpatient departments
  • Ambulatory surgical centers
  • Physician offices
• Claims for reimbursement must include a unique geographical identifier code, which identifies the specific location of the healthcare provider, aligning with the established reimbursement rates.

Effective Date

The amendments proposed in this bill are set to take effect on January 1, 2026.

Implications

The bill is intended to streamline and standardize how TRICARE pays for healthcare services based on where those services are provided. This could influence how healthcare providers perceive the financial viability of serving TRICARE patients based on location.

Relevant Companies

• HCA Healthcare (HCA) - As a major healthcare provider operating hospitals and outpatient centers, changes in TRICARE reimbursement rates could significantly affect their revenue from services provided to military families.
• Universal Health Services (UHS) - Similar to HCA, this company manages hospitals and various healthcare facilities and could be directly impacted by adjustments in reimbursement rates linked to the locations of their services.
• Athenahealth (ATHN) - As a provider of healthcare technology services, especially in relation to billing and reimbursements, changes in TRICARE reimbursements may affect their service delivery and financial planning for healthcare providers.