; and (2) by adding at the end the following new paragraph: (18) Acupuncturist services may be provided without the requirement of a referral if performed by an acupuncturist who is licensed or certified in the State in which the services are furnished, or, in the case of services furnished in a State that does not provide for such licensure or certification, meets such criteria (such as accreditation through an appropriate nationally recognized certification authority for acupuncturists) as the Secretary may specify. In specifying such requirements, the Secretary may use the same requirements as those established by such a certification authority. . (c) Effective date The amendments made by this section shall take effect on the date that is 180 days after the date of the enactment of this Act. 4. Acupuncture health services for TRICARE program beneficiaries (a) Plan required Not later than 90 days after the date of the enactment of this Act, the Secretary of Defense shall develop a plan to provide qualified acupuncturist services, as a permanent part of the TRICARE program pursuant to the amendments made by section 3, for covered beneficiaries (as defined in section 1072 of title 10, United States Code). (b) Contents of plan The plan shall require that a contract entered into under section 1097 of title 10, United States Code, for the delivery of health care services shall— (1) include the delivery of qualified acupuncturist services; (2) require that qualified acupuncturist services may be provided only by a qualified acupuncturist