§ 1079.
(a)
(1)
With respect to dental care—
(A)
except as provided in subparagraph (B), only that care required as a necessary adjunct to medical or surgical treatment may be provided; and
(B)
in connection with dental treatment for patients with developmental, mental, or physical disabilities or for pediatric patients age 5 or under, only institutional and anesthesia services may be provided.
(2)
Consistent with such regulations as the Secretary of Defense may prescribe regarding the content of health promotion and disease prevention visits, the schedule and method of cervical cancer screenings and breast cancer screenings, the schedule and method of colon and prostate cancer screenings, and the types and schedule of immunizations—
(A)
for dependents under six years of age, both health promotion and disease prevention visits and immunizations may be provided; and
(B)
for dependents six years of age or older, health promotion and disease prevention visits may be provided in connection with immunizations or with diagnostic or preventive cervical and breast cancer screenings or colon and prostate cancer screenings.
(3)
Not more than one eye examination may be provided to a patient in any calendar year.
(4)
Under joint regulations to be prescribed by the administering Secretaries, the services of Christian Science practitioners and nurses and services obtained in Christian Science sanatoriums may be provided.
(5)
Durable equipment provided under this section may be provided on a rental basis.
(6)
Services in connection with nonemergency inpatient hospital care may not be provided if such services are available at a facility of the uniformed services located within a 40-mile radius of the residence of the patient, except that those services may be provided in any case in which another insurance plan or program provides primary coverage for those services.
(7)
Services of pastoral counselors, family and child counselors, or marital counselors (other than certified marriage and family therapists) may not be provided unless the patient has been referred to the counselor by a medical doctor for treatment of a specific problem with the results of that treatment to be communicated back to the medical doctor who made the referral and services of certified marriage and family therapists may be provided consistent with such rules as may be prescribed by the Secretary of Defense, including credentialing criteria and a requirement that the therapists accept payment under this section as full payment for all services provided.
(8)
Special education may not be provided, except when provided as secondary to the active psychiatric treatment on an institutional inpatient basis.
(9)
Therapy or counseling for sexual dysfunctions or sexual inadequacies may not be provided.
(10)
Treatment of obesity may not be provided if obesity is the sole or major condition treated.
(11)
Surgery which improves physical appearance but is not expected to significantly restore functions (including mammary augmentation, face lifts, and sex gender changes) may not be provided, except that—
(A)
breast reconstructive surgery following a mastectomy may be provided;
(B)
reconstructive surgery to correct serious deformities caused by congenital anomalies or accidental injuries may be provided; and
(C)
neoplastic surgery may be provided.
(12)
Any service or supply which is not medically or psychologically necessary to prevent, diagnose, or treat a mental or physical illness, injury, or bodily malfunction as assessed or diagnosed by a physician, dentist, clinical psychologist, certified marriage and family therapist, optometrist, podiatrist, certified nurse-midwife, certified nurse practitioner, certified clinical social worker, or other class of provider as designated by the Secretary of Defense, as appropriate, may not be provided, except as authorized in paragraph (4). Pursuant to an agreement with the Secretary of Health and Human Services and under such regulations as the Secretary of Defense may prescribe, the Secretary of Defense may waive the operation of this paragraph in connection with clinical trials sponsored or approved by the National Institutes of Health if the Secretary of Defense determines that such a waiver will promote access by covered beneficiaries to promising new treatments and contribute to the development of such treatments.
(14)
Electronic cardio-respiratory home monitoring equipment (apnea monitors) for home use may be provided if a physician prescribes and supervises the use of the monitor for an infant—
(A)
who has had an apparent life-threatening event,
(B)
who is a subsequent sibling of a victim of sudden infant death syndrome,
(C)
whose birth weight was 1,500 grams or less, or
(D)
who is a pre-term infant with pathologic apnea,
in which case the coverage may include the cost of the equipment, hard copy analysis of physiological alarms, professional visits, diagnostic testing, family training on how to respond to apparent life threatening events, and assistance necessary for proper use of the equipment.
(15)
Hospice care may be provided only in the manner and under the conditions provided in section 1861(dd) of the Social Security Act (
42 U.S.C. 1395x(dd)), except that hospice care may be provided to an individual under the age of 21 concurrently with health care services or hospitalization for the same condition.
(16)
Forensic examinations following a sexual assault or domestic violence may be provided.
(17)
Breastfeeding support, supplies (including breast pumps and associated equipment), and counseling shall be provided as appropriate during pregnancy and the postpartum period.
(18)
Treatment for eating disorders may be provided in accordance with subsection (r).
(19)
Preconception and prenatal carrier screening tests shall be provided to eligible covered beneficiaries, with a limit per beneficiary of one test per condition per lifetime, for the following conditions:
(B)
Spinal Muscular Atrophy.
(F)
Conditions linked with Ashkenazi Jewish descent.
(Added [Pub. L. 85–861, § 1(25)(B)], Sept. 2, 1958, [72 Stat. 1448]; amended [Pub. L. 89–614, § 2(6)], Sept. 30, 1966, [80 Stat. 863]; [Pub. L. 92–58, § 1], July 29, 1971, [85 Stat. 157]; [Pub. L. 95–485, title VIII, § 806(a)(1)], Oct. 20, 1978, [92 Stat. 1622]; [Pub. L. 96–342, title VIII, § 810(a)], (b), Sept. 8, 1980, [94 Stat. 1097]; [Pub. L. 96–513, title V], §§ 501(13), 511(36), (38), Dec. 12, 1980, [94 Stat. 2908], 2923; [Pub. L. 96–552], Dec. 19, 1980, [94 Stat. 3254]; [Pub. L. 97–22, § 11(a)(2)], July 10, 1981, [95 Stat. 137]; [Pub. L. 97–86, title IX, § 906(a)(1)], Dec. 1, 1981, [95 Stat. 1117]; [Pub. L. 98–94, title IX, § 931(a)], title XII, § 1268(4), Sept. 24, 1983, [97 Stat. 648], 705; [Pub. L. 98–525, title VI, § 632(a)(1)], title XIV, §§ 1401(e)(4), 1405(23), Oct. 19, 1984, [98 Stat. 2543], 2617, 2623; [Pub. L. 98–557, § 19(7)], Oct. 30, 1984, [98 Stat. 2869]; [Pub. L. 99–661, div. A, title VI, § 652(d)], title VII, § 703, Nov. 14, 1986, [100 Stat. 3889], 3900; [Pub. L. 100–180, div. A, title VII], §§ 721(a), 726(a), Dec. 4, 1987, [101 Stat. 1115], 1117; [Pub. L. 100–456, div. A, title VI, § 646(a)], Sept. 29, 1988, [102 Stat. 1989]; [Pub. L. 101–189, div. A, title VII, § 730(a)], Nov. 29, 1989, [103 Stat. 1481]; [Pub. L. 101–510, div. A, title VII], §§ 701(a), 702(a), 703(a), (b), 712(a), title XIV, § 1484(g)(1), Nov. 5, 1990, [104 Stat. 1580], 1581, 1583, 1717; [Pub. L. 102–25, title III, § 316(b)], Apr. 6, 1991, [105 Stat. 87]; [Pub. L. 102–190, div. A, title VII], §§ 702(b), 711, 712(a), 713, Dec. 5, 1991, [105 Stat. 1400], 1402, 1403; [Pub. L. 102–484, div. A, title VII, § 704], title X, §§ 1052(13), 1053(3), Oct. 23, 1992, [106 Stat. 2432], 2499, 2501; [Pub. L. 103–35, title II, § 202(a)(5)], May 31, 1993, [107 Stat. 101]; [Pub. L. 103–160, div. A, title VII], §§ 711, 716(c), Nov. 30, 1993, [107 Stat. 1688], 1693; [Pub. L. 103–337, div. A, title VII], §§ 702(a), 707(a), Oct. 5, 1994, [108 Stat. 2797], 2800; [Pub. L. 104–106, div. A, title VII], §§ 701, 731(a)–(d), Feb. 10, 1996, [110 Stat. 370], 380, 381; [Pub. L. 104–201, div. A, title VII], §§ 701(b)(2), 711, 731, 732, 735(c), Sept. 23, 1996, [110 Stat. 2587], 2590, 2597, 2599; [Pub. L. 105–85, div. A, title VII, § 735], Nov. 18, 1997, [111 Stat. 1813]; [Pub. L. 106–398, § 1 [[div. A]], title VII, §§ 701(c)(1), 704(b), 722(b)(1), 757(a)], Oct. 30, 2000, [114 Stat. 1654], 1654A–172, 1654A–175, 1654A–185, 1654A–198; [Pub. L. 107–107, div. A, title VII], §§ 701(b), (g)(2), 703(b), 707(a), (b), title X, § 1048(c)(5), Dec. 28, 2001, [115 Stat. 1158], 1161–1163, 1226; [Pub. L. 107–314, div. A, title VII], §§ 701(a), § 702, § 705(a), Dec. 2, 2002, [116 Stat. 2583], 2584; [Pub. L. 108–375, div. A, title VII, § 705], Oct. 28, 2004, [118 Stat. 1983]; [Pub. L. 109–163, div. A, title VII], §§ 714, 715(a),