Sponsors (17)
Official 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.
Introduced February 27, 2025 by Steven Horsford · Last progress February 27, 2025
The bill improves timely OB/GYN access and continuity of care for female TRICARE Prime beneficiaries and adds reporting transparency, but it may raise DoD health costs, create short-term implementation burdens, and is limited in scope as an opt-in pilot.
Female TRICARE Prime beneficiaries gain direct access to OB/GYN care without prior referral and can have OB/GYNs serve as designated primary care managers, improving timely reproductive and preventive services and care coordination.
Taxpayers and policymakers receive better transparency because the Department of Defense must report to congressional defense committees on enrollment and costs within four years, enabling oversight of program impacts and budgetary effects.
Taxpayers and the DoD budget may face higher costs because expanding direct OB/GYN access and allowing OB/GYNs as primary care managers could increase utilization and program spending.
The Department of Defense and provider organizations will incur short‑term administrative and network reorganization burdens to implement OB/GYNs as designated primary care managers and to update systems and processes.
Eligible benefits initially apply only to female TRICARE Prime beneficiaries who opt into the pilot, so many beneficiaries and other TRICARE enrollees will not immediately receive the expanded access.
Based on analysis of 2 sections of legislative text.
Creates a five-year TRICARE Prime pilot allowing female beneficiaries direct OB/GYN care without referrals and to elect an OB/GYN as an additional primary care manager.
Creates a five-year TRICARE Prime pilot to let female TRICARE Prime beneficiaries obtain obstetrical and gynecological (OB/GYN) care without a referral and to permit electing an OB/GYN as an additional designated primary care manager. The Department of Defense must start the pilot within 180 days and report to congressional defense committees within four years on enrollment, costs, and other effects.