---
kind: "section"
citation: "10 U.S.C. § 1097b"
title: "10"
title_heading: "Armed Forces"
number: "1097b"
heading: "TRICARE program: financial management"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/10/1097b"
units:
  - "Subtitle A — General Military Law"
  - "Part II — Personnel"
  - "Chapter 55 — Medical and Dental Care"
---

# §1097b. TRICARE program: financial management

- (a) **Reimbursement of Providers.—**
  - (1) Subject to [paragraph (2)](#a-2), the [Secretary](/usc/10/4951.md?p=3) of Defense may reimburse [health care](/usc/10/1072.md?p=10) providers under the [TRICARE program](/usc/10/1072.md?p=7) at [rates](/usc/10/101.md?p=b-9) higher than the reimbursement [rates](/usc/10/101.md?p=b-9) otherwise authorized for the providers under that [program](/usc/10/2101.md?p=1) if the [Secretary](/usc/10/4951.md?p=3) determines that application of the higher [rates](/usc/10/101.md?p=b-9) is necessary in order to ensure the availability of an adequate number of qualified [health care](/usc/10/1072.md?p=10) providers under that [program](/usc/10/2101.md?p=1).
  - (2) The amount of reimbursement provided under [paragraph (1)](#a-1) with respect to a [health care](/usc/10/1072.md?p=10) service may not exceed the lesser of the following:
    - (A) The amount equal to the local fee for service charge for the service in the service area in which the service is provided as determined by the [Secretary](/usc/10/4951.md?p=3) based on one or more of the following payment [rates](/usc/10/101.md?p=b-9):
      - (i) Usual, customary, and reasonable.
      - (ii) The [Health Care](/usc/10/1072.md?p=10) Finance Administration’s Resource Based Relative Value Scale.
      - (iii) Negotiated fee schedules.
      - (iv) Global fees.
      - (v) Sliding scale individual fee allowances.
    - (B) The amount equal to 115 percent of the CHAMPUS maximum allowable charge for the service.
  - (3) In establishing [rates](/usc/10/101.md?p=b-9) and procedures for reimbursement of providers and other administrative requirements, including those contained in provider network agreements, the [Secretary](/usc/10/4951.md?p=3) shall, to the extent practicable, maintain adequate networks of providers, including institutional, professional, and pharmacy. For the purpose of determining whether network providers under such provider network agreements are subcontractors for purposes of the Federal Acquisition Regulation or any other law, a TRICARE managed care support contract that [includes](/usc/10/101.md?p=g-4) the requirement to establish, manage, or maintain a network of providers may not be considered to be a contract for the performance of [health care](/usc/10/1072.md?p=10) services or [supplies](/usc/10/3011.md?p=8) on the basis of such requirement.
- (b) **Third-Party Collections.—**
  - (1) A medical treatment [facility](/usc/10/2700.md?p=2) of the [uniformed services](/usc/10/1072.md?p=1) under the [TRICARE program](/usc/10/1072.md?p=7) has the same right as the [United States](/usc/10/101.md?p=a-1) under [section 1095 of this title](/usc/10/1095.md) to collect from a third-party payer the reasonable charges for [health care](/usc/10/1072.md?p=10) services described in [paragraph (2)](#b-2) that are incurred by the [facility](/usc/10/2700.md?p=2) on behalf of a [covered beneficiary](/usc/10/1072.md?p=5) under that [program](/usc/10/2101.md?p=1).
  - (2) The [Secretary](/usc/10/4951.md?p=3) of Defense shall prescribe regulations for the administration of this subsection. The regulations shall set forth the method to be used for the computation of the reasonable charges for inpatient, outpatient, and other [health care](/usc/10/1072.md?p=10) services. The method of computation may be—
    - (A) a method that is based on—
      - (i) per diem [rates](/usc/10/101.md?p=b-9);
      - (ii) all-inclusive [rates](/usc/10/101.md?p=b-9) for each visit;
      - (iii) diagnosis-related groups; or
      - (iv) [rates](/usc/10/101.md?p=b-9) prescribed under the regulations implementing sections [1079](/usc/10/1079.md) and [1086](/usc/10/1086.md) of this title; or
    - (B) any other method considered appropriate.
- (c) **Consultation Requirement.—** The [Secretary](/usc/10/4951.md?p=3) of Defense shall carry out the responsibilities under this section after consultation with the other [administering Secretaries](/usc/10/1072.md?p=3).

## Source credit

(Added Pub. L. 106–65, div. A, title VII, § 716(a)(1), Oct. 5, 1999, 113 Stat. 690; amended Pub. L. 112–81, div. A, title VII, § 715, Dec. 31, 2011, 125 Stat. 1477.)

## Notes

### Editorial Notes

### Amendments

2011—Subsec. (a)(3). Pub. L. 112–81 added par. (3).

### Statutory Notes and Related Subsidiaries

### Effective Date

Pub. L. 106–65, div. A, title VII, § 716(d), Oct. 5, 1999, 113 Stat. 692, provided that: “The amendments made by subsection (a) [enacting this section] shall take effect one year after the date of the enactment of this Act [Oct. 5, 1999].”

### Report on Implementation

Pub. L. 106–65, div. A, title VII, § 716(b), Oct. 5, 1999, 113 Stat. 691, directed the Secretary of Defense to submit to Congress a report assessing the effects of the implementation of the requirements and authorities set forth in this section not later than 6 months after Oct. 5, 1999.