§ 1077 — Medical Care For Dependents: Authorized Care In Facilities Of Uniformed Services

(a) Only the following types of health care may be provided under section 1076 of this title: (1) Hospitalization. (2) Outpatient care. (3) Drugs, including, in accordance with subsection (h), medically necessary vitamins. (4) Treatment of medical and surgical conditions. (5) Treatment of nervous, mental, and chronic conditions. (6) Treatment of contagious diseases. (7) Physical examinations, including eye examinations, and immunizations. (8) Maternity and infant care, including well-baby care that includes one screening of an infant for the level of lead in the blood of the infant. (9) Diagnostic tests and services, including laboratory and X-ray examinations. (10) Dental care. (11) Ambulance service and home calls when medically necessary. (12) Durable equipment, which may be provided on a loan basis. (13) Primary and preventive health care services for women (as defined in section 1074d(b) of this title). (14) Preventive health care screening for colon or prostate cancer, at the intervals and using the screening methods prescribed under section 1074d(a)(2) of this title. (15) Prosthetic devices, as determined by the Secretary of Defense to be necessary because of significant conditions resulting from trauma, congenital anomalies, or disease. (16) Except as provided by subsection (g), a hearing aid, but only if the dependent has a profound hearing loss, as determined under standards prescribed in regulations by the Secretary of Defense in consultation with the administering Secretaries, and only for the following dependents: (A) A dependent of a member of the uniformed services on active duty. (B) A dependent under subparagraph (D) or (I) of section 1072(2) of this title of a former member of the uniformed services who— (i) is entitled to retired or retainer pay, or equivalent pay; and (ii) is enrolled in family coverage under TRICARE Prime. (17) Any rehabilitative therapy to improve, restore, or maintain function, or to minimize or prevent deterioration of function, of a patient when prescribed by a physician. (18) In accordance with subsection (h), medically necessary food and the medical equipment and supplies necessary to administer such food (other than durable medical equipment and supplies). (b) The following types of health care may not be provided under section 1076 of this title: (1) Domiciliary or custodial care. (2) Orthopedic footwear and spectacles, except that, outside of the United States and at stations inside the United States where adequate civilian facilities are unavailable, such items may be sold to dependents at cost to the United States. (3) The elective correction of minor dermatological blemishes and marks or minor anatomical anomalies. (1) Except as specified in paragraphs (2) and (3), a dependent participating under a dental plan established under section 1076a of this title may not be provided dental care under section 1076(a) of this title except for emergency dental care, dental care provided outside the United States, and dental care that is not covered by such plan. (A) Dependents who are 12 years of age or younger and are covered by a dental plan established under section 1076a of this title may be treated by postgraduate dental residents in a dental treatment facility of the uniformed services under a graduate dental education program accredited by the American Dental Association if— (i) treatment of pediatric dental patients is necessary in order to satisfy an accreditation standard of the American Dental Association that is applicable to such program, or training in pediatric dental care is necessary for the residents to be professionally qualified to provide dental care for dependent children accompanying members of the uniformed services outside the United States; and (ii) the number of pediatric patients at such facility is insufficient to support satisfaction of the accreditation or professional requirements in pediatric dental care that apply to such program or students. (B) The total number of dependents treated in all facilities of the uniformed services under subparagraph (A) in a fiscal year may not exceed 2,000. (A) Dependents who reside within a specified geographic area and are covered by a dental plan established under section 1076a may receive dental care in a dental treatment facility of the uniformed services on a space available basis if the Secretary of Defense determines that— (i) civilian dental care within the specified geographic area is inadequate or is not sufficiently available; and (ii) adequate resources exist to provide space available dental care to the dependents at the facility. (B) Care under subparagraph (A) shall be provided on a reimbursable basis. (1) Notwithstanding subsection (b)(1), hospice care may be provided under section 1076 of this title in facilities of the uniformed services to a terminally ill patient who chooses (pursuant to regulations prescribed by the Secretary of Defense in consultation with the other administering Secretaries) to receive hospice care rather than continuing hospitalization or other health care services for treatment of the patient’s terminal illness. (2) In this section, the term “hospice care” means the items and services described in section 1861(dd) of the Social Security Act (42 U.S.C. 1395x(dd)). (1) Authority to provide a prosthetic device under subsection (a)(15) includes authority to provide the following: (A) Any accessory or item of supply that is used in conjunction with the device for the purpose of achieving therapeutic benefit and proper functioning. (B) Services necessary to train the recipient of the device in the use of the device. (C) Repair of the device for normal wear and tear or damage. (D) Replacement of the device if the device is lost or irreparably damaged or the cost of repair would exceed 60 percent of the cost of replacement. (2) An augmentative communication device may be provided as a voice prosthesis under subsection (a)(15). (3) A prosthetic device customized for a patient may be provided under this section only by a prosthetic practitioner who is qualified to customize the device, as determined under regulations prescribed by the Secretary of Defense in consultation with the administering Secretaries. (1) Items that may be provided to a patient under subsection (a)(12) include the following: (A) Any durable medical equipment that can improve, restore, or maintain the function of a malformed, diseased, or injured body part, or can otherwise minimize or prevent the deterioration of the patient’s function or condition. (B) Any durable medical equipment that can maximize the patient’s function consistent with the patient’s physiological or medical needs. (C) Wheelchairs. (D) Iron lungs. (E) Hospital beds. (2) In addition to the authority to provide durable medical equipment under subsection (a)(12), any customization of equipment owned by the patient that is durable medical equipment authorized to be provided to the patient under this section or section 1079(a)(5) of this title, and any accessory or item of supply for any such equipment, may be provided to the patient if the customization, accessory, or item of supply is essential for— (A) achieving therapeutic benefit for the patient; (B) making the equipment serviceable; or (C) otherwise assuring the proper functioning of the equipment. (1) In addition to the authority to provide a hearing aid under subsection (a)(16), hearing aids may be sold under this section to dependents eligible for care under this section at cost to the United States. (2) For purposes of selling hearing aids at cost to the United States under paragraph (1), a dependent of a member of the reserve components who is enrolled in the TRICARE program under section 1076d of this title shall be deemed to be a dependent eligible for care under this section. (1) Vitamins that may be provided under subsection (a)(3) are vitamins used for the management of a covered disease or condition pursuant to the prescription, order, or recommendation (as applicable) of a physician or other health care professional qualified to make such prescription, order, or recommendation. (2) Medically necessary food that may be provided under subsection (a)(18)— (A) is food, including a low protein modified food product or an amino acid preparation product, that is— (i) furnished pursuant to the prescription, order, or recommendation (as applicable) of a physician or other health care professional qualified to make such prescription, order, or recommendation, for the dietary management of a covered disease or condition; (ii) a specially formulated and processed product (as opposed to a naturally occurring foodstuff used in its natural state) for the partial or exclusive feeding of an individual by means of oral intake or enteral feeding by tube; (iii) intended for the dietary management of an individual who, because of therapeutic or chronic medical needs, has limited or impaired capacity to ingest, digest, absorb, or metabolize ordinary foodstuffs or certain nutrients, or who has other special medically determined nutrient requirements, the dietary management of which cannot be achieved by the modification of the normal diet alone; (iv) intended to be used under medical supervision, which may include in a home setting; and (v) intended only for an individual receiving active and ongoing medical supervision under which the individual requires medical care on a recurring basis for, among other things, instructions on the use of the food; and (B) may not include— (i) food taken as part of an overall diet designed to reduce the risk of a disease or medical condition or as weight-loss products, even if the food is recommended by a physician or other health care professional; (ii) food marketed as gluten-free for the management of celiac disease or non-celiac gluten sensitivity; (iii) food marketed for the management of diabetes; or (iv) such other products as the Secretary determines appropriate. (3) In this subsection, the term “covered disease or condition” means— (A) inborn errors of metabolism; (B) medical conditions of malabsorption; (C) pathologies of the alimentary tract or the gastrointestinal tract; (D) a neurological or physiological condition; and (E) such other diseases or conditions the Secretary determines appropriate.