Who determines TRICARE reimbursement rates?
Congress passed the Defense Appropriations Act establishing the uniform payment system for the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), called the CHAMPUS maximum allowable charge (CMAC). When TRICARE was implemented, the TRICARE Enabling Statute [Title 10, United States Code, Section 1079(h)(1)] gave the Secretary of Defense the authority to set the reimbursement rates for health care services provided to TRICARE beneficiaries. Those rates are set in accordance with the same reimbursement rules that apply to payments for similar services under Medicare [Title XVIII of the Social Security Act (Title 42, United States Code, Section 1395)].
