S.Amdt. 6690

SA 6690, submitted by Mr. Sheehy, aims to change how payment rates are handled for providers of care or services under the TRICARE program.

The amendment adds a section to modify the rates of pay based on the specific site where the care or service is actually provided, regardless of where the provider's headquarters is located. The specified sites include:

• A hospital outpatient department.
• An ambulatory surgical center.
• The office of a physician.
• Other sites the Secretary determines are appropriate.

To implement this, the amendment requires each site to have a separate and unique National Provider Identifier. Payments will not be made unless the claim includes the identifier for the specific site where the services were furnished.

The amendment also includes specific rules for off-campus outpatient departments, requiring them to be treated as a subpart of the provider with a unique health identifier. It specifies that members of the uniformed services or covered beneficiaries cannot be held liable for items or services unless they are billed using that separate identifier.

The amendment clarifies that these changes do not stop the Secretary from determining facility fee amounts or affect the payment differences between independent and hospital-based physicians. These changes are set to take effect on January 1, 2028.