```

[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4341 Introduced in House (IH)]

112th CONGRESS
  2d Session
                                H. R. 4341

  To direct the Secretary of Defense to establish a working group to 
review TRICARE policy with respect to providing health care to children 
   and determine how to improve such policy, and for other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             March 29, 2012

Mr. Stivers (for himself, Mr. Schilling, and Mrs. Davis of California) 
 introduced the following bill; which was referred to the Committee on 
                             Armed Services

_______________________________________________________________________

                                 A BILL

 
  To direct the Secretary of Defense to establish a working group to 
review TRICARE policy with respect to providing health care to children 
   and determine how to improve such policy, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SENSE OF CONGRESS.

    It is the sense of Congress that--
            (1) children of members of the Armed Forces deserve health-
        care practices and policies that--
                    (A) are designed to meet their pediatric-specific 
                needs;
                    (B) are developed and determined proactively and 
                comprehensively; and
                    (C) ensure and maintain their access to pediatric-
                specific treatments, providers, and facilities;
            (2) children's health-care needs and standards of care are 
        different and distinct from those of adults, therefore the 
        TRICARE program should undertake a proactive, comprehensive 
        approach to review and analyze its policies and practices to 
        meet the needs of children to ensure that children and their 
        families receive appropriate care in proper settings and avoid 
        unnecessary challenges in seeking or obtaining proper health 
        care;
            (3) a proactive and comprehensive review is necessary 
        because the reimbursement structure of the TRICARE program is 
        patterned upon Medicare and the resulting policies and 
        practices of the TRICARE program do not always properly reflect 
        appropriate standards for pediatric care;
            (4) one distinct aspect of children's health care is the 
        need for specialty care and services for children with special-
        health-care needs and chronic-health conditions;
            (5) the requirement for specialized health care and 
        developmental support is an ongoing and serious matter of day-
        to-day life for families with children with special or chronic-
        health-care needs;
            (6) the Department of Defense and the TRICARE program, 
        recognizing the special needs of certain children, have 
        instituted special-needs programs, including the ECHO program, 
        but there are collateral needs that are not being met, 
        generally because the services are provided in the local 
        community rather than by the Department of Defense, who may not 
        always have the best tools or knowledge to access these State 
        and local resources;
            (7) despite wholehearted efforts by the Department of 
        Defense, a gap exists between linking military families with 
        children with special-health-care needs and chronic conditions 
        with the resources and services available from local or 
        regional highly specialized providers and the communities and 
        States in which they reside;
            (8) the gap is especially exacerbated by the mobility of 
        military families, who often move from State to State, because 
        special-needs health care, educational, and social services are 
        very specific to each local community and State and such 
        services often have lengthy waiting lists; and
            (9) the Department of Defense will be better able to assist 
        military families with children with special-health-care needs 
        fill the gap by collaborating with special-health-care needs 
        providers and those knowledgeable about the opportunities for 
        such children that are provided by States and local 
        communities.

SEC. 2. ESTABLISHMENT OF TRICARE WORKING GROUP.

    (a) Establishment.--
            (1) In general.--The Secretary of Defense shall establish a 
        working group to carry out a review of the TRICARE program with 
        respect to--
                    (A) pediatric health care needs under paragraph 
                (2); and
                    (B) pediatric special and chronic health care needs 
                under paragraph (3).
            (2) Pediatric health care needs.--
                    (A) Duties.--The working group shall--
                            (i) comprehensively review the policy and 
                        practices of the TRICARE program with respect 
                        to providing pediatric health care;
                            (ii) recommend changes to such policies and 
                        practices to ensure that--
                                    (I) children receive appropriate 
                                care in an appropriate manner, at the 
                                appropriate time, and in an appropriate 
                                setting; and
                                    (II) access to care and treatment 
                                provided by pediatric providers and 
                                children's hospitals remains available 
                                for families with children; and
                            (iii) develop a plan to implement such 
                        changes.
                    (B) Review.--In carrying out the duties under 
                subparagraph (A), the working group shall--
                            (i) identify improvements in policies, 
                        practices, and administration of the TRICARE 
                        program with respect to pediatric-specific 
                        health care and pediatric-specific healthcare 
                        settings;
                            (ii) analyze the direct and indirect 
                        effects of the reimbursement policies and 
                        practices of the TRICARE program with respect 
                        to pediatric care and care provided in 
                        pediatric settings;
                            (iii) consider case management programs 
                        with respect to pediatric complex and chronic 
                        care, including whether pediatric specific 
                        programs are necessary;
                            (iv) develop a plan to ensure that the 
                        TRICARE program addresses pediatric-specific 
                        health care needs on an on-going basis beyond 
                        the life of the working group;
                            (v) consider how the TRICARE program can 
                        work with the pediatric provider community to 
                        ensure access, promote communication and 
                        collaboration, and optimize experiences of 
                        military families seeking and receiving health 
                        care services for children; and
                            (vi) review matters that further the 
                        mission of the working group.
            (3) Pediatric special and chronic health care needs.--
                    (A) Duties.--The working group shall--
                            (i) review the methods in which families in 
                        the TRICARE program who have children with 
                        special-health-care needs access community 
                        resources and health-care resources;
                            (ii) review how having access to, and a 
                        better understanding of, community resources 
                        may improve access to health care and support 
                        services;
                            (iii) recommend methods to accomplish 
                        improved access by such children and families 
                        to community resources and health-care 
                        resources, including through collaboration with 
                        children's hospitals and other providers of 
                        pediatric specialty care, local agencies, local 
                        communities, and States;
                            (iv) consider approaches and make 
                        recommendations for the improved integration of 
                        individualized or compartmentalized medical and 
                        family support resources for military families;
                            (v) work closely with the Office of 
                        Community Support for Military Families with 
                        Special Needs of the Department of Defense and 
                        other relevant offices to avoid redundancies 
                        and target shared areas of concern for children 
                        with special or chronic-health-care needs; and
                            (vi) review any relevant information 
                        learned and findings made by the working group 
                        under this paragraph that may be considered or 
                        adopted in a consistent manner with respect to 
                        improving access, resources, and services for 
                        adults with special needs.
                    (B) Review.--In carrying out the duties under 
                subparagraph (A), the working group shall--
                            (i) discuss improvements to special needs 
                        health care policies and practices;
                            (ii) determine how to support and protect 
                        families of members of the National Guard or 
                        Reserve Components as the members transition 
                        into and out of the relevant Exceptional Family 
                        Member Program or the ECHO program;
                            (iii) analyze case management services to 
                        improve consistency, communication, knowledge, 
                        and understanding of resources and community 
                        contacts;
                            (iv) identify areas in which a State may 
                        offer services that are not covered by the 
                        TRICARE program or the ECHO program and how to 
                        coordinate such services;
                            (v) identify steps that States and 
                        communities can take to improve support for 
                        military families of children with special 
                        health care needs;
                            (vi) consider how the TRICARE program and 
                        other programs of the Department of Defense can 
                        work with specialty pediatric providers and 
                        resource communities to ensure access, promote 
                        communication and collaboration, and optimize 
                        experiences of military families seeking and 
                        receiving health care services for their 
                        children with special or chronic health care 
                        needs;
                            (vii) consider special and chronic health 
                        care in a comprehensive manner without focus on 
                        one or more conditions or diagnoses to the 
                        exclusion of others;
                            (viii) focus on ways to create innovative 
                        partnerships, linkages, and access to 
                        information and resources for military families 
                        across the spectrum of the special-needs 
                        community and between the medical community and 
                        the family support community; and
                            (ix) review matters that further the 
                        mission of the working group.
    (b) Membership.--
            (1) Appointments.--The working group shall be composed of 
        not less than 14 members as follows:
                    (A) The Chief Medical Officer of the TRICARE 
                program, who shall serve as chairperson.
                    (B) The Chief Medical Officers of the North, South, 
                and West regional offices of the TRICARE program.
                    (C) One individual representing the Army appointed 
                by the Surgeon General of the Army.
                    (D) One individual representing the Navy appointed 
                by the Surgeon General of the Navy.
                    (E) One individual representing the Air Force 
                appointed by the Surgeon General of the Air Force.
                    (F) One individual representing the regional 
                managed care support contractor of the North region of 
                the TRICARE program appointed by such contractor.
                    (G) One individual representing the regional 
                managed care support contractor of the South region of 
                the TRICARE program appointed by such contractor.
                    (H) One individual representing the regional 
                managed care support contractor of the West region of 
                the TRICARE program appointed by such contractor.
                    (I) Not more than three individuals representing 
                the non-profit organization the Military Coalition 
                appointed by such organization.
                    (J) One individual representing the American 
                Academy of Pediatrics appointed by such organization.
                    (K) One individual representing the National 
                Association of Children's Hospitals appointed by such 
                organization.
                    (L) One individual representing military families 
                who is not an employee of an organization representing 
                such families.
                    (M) Any other individual as determined by the Chief 
                Medical Officer of the TRICARE program.
            (2) Terms.--Each member shall be appointed for the life of 
        the working group. A vacancy in the working group shall be 
        filled in the manner in which the original appointment was 
        made.
            (3) Travel expenses.--Each member shall receive travel 
        expenses, including per diem in lieu of subsistence, in 
        accordance with applicable provisions under subchapter I of 
        chapter 57 of title 5, United States Code.
            (4) Staff.--The Secretary of Defense shall ensure that 
        employees of the TRICARE program provide the working group with 
        the necessary support to carry out this section.
    (c) Meetings.--
            (1) Schedule.--The working group shall--
                    (A) convene its first meeting not later than 60 
                days after the date of the enactment of this Act; and
                    (B) convene not less than four other times.
            (2) Form.--Any meeting of the working group may be 
        conducted in-person or through the use of video conferencing.
            (3) Quorum.--Seven members of the working group shall 
        constitute a quorum but a lesser number may hold hearings.
    (d) Powers.--
            (1) Hearings and testimony.--The working group may, for the 
        purpose of carrying out this Act, hold public or private 
        hearings, sit and act at times and places, take written or oral 
        comments or testimony, and receive evidence as the working 
        group considers appropriate.
            (2) Official information.--The working group may secure 
        directly from any department or agency of the United States 
        information necessary to enable it to carry out this Act.
            (3) Mails.--The working group may use the United States 
        mails in the same manner and under the same conditions as other 
        departments and agencies of the United States.
    (e) Consultation.--
            (1) Advice.--With respect to carrying out the review of the 
        TRICARE program and pediatric special and chronic health care 
        needs under subsection (a)(3), the working group shall seek 
        counsel from the following individuals acting as an expert 
        advisory group:
                    (A) One individual representing the Exceptional 
                Family Member Program of the Army.
                    (B) One individual representing the Exceptional 
                Family Member Program of the Navy.
                    (C) One individual representing the Exceptional 
                Family Member Program of the Air Force.
                    (D) One individual representing the Exceptional 
                Family Member Program of the Marine Corps.
                    (E) One individual representing the Office of 
                Community Support for Military Families with Special 
                Needs.
                    (F) One individual who is not an employee of an 
                organization representing military families shall 
                represent a military family with a child with special 
                health care needs.
                    (G) Not more than three individuals representing 
                organizations that--
                            (i) are not otherwise represented in this 
                        paragraph or in the working group; and
                            (ii) possess expertise needed to carry out 
                        the goals of the working group.
            (2) Comments.--With respect to carrying out the review of 
        the TRICARE program and pediatric special and chronic health 
        care needs under subsection (a)(3), the working group shall 
        invite and accept comments and testimony from States, local 
        communities, national special needs advocacy groups, educators, 
        pediatric-health-care providers, and military family advocates.
    (f) Reports Required.--
            (1) Report.--Not later than 12 months after the date on 
        which the working group convenes its first meeting, the working 
        group shall submit to the congressional defense committees a 
        report including--
                    (A) any changes described in subsection 
                (a)(2)(A)(ii) identified by the working group that--
                            (i) require legislation to carry out, 
                        including proposed legislative language for 
                        such changes;
                            (ii) require regulations to carry out, 
                        including proposed regulatory language for such 
                        changes; and
                            (iii) may be carried out without 
                        legislation or regulations, including a time 
                        line for such changes; and
                    (B) steps that States and local communities may 
                take to improve the experiences of military families 
                with special-needs children in interacting with and 
                accessing State and local community resources.
            (2) Final report.--Not later than 18 months after the date 
        on which the report is submitted under paragraph (1), the 
        working group shall submit to the congressional defense 
        committees a final report including--
                    (A) any additional information and updates to the 
                report submitted under paragraph (1);
                    (B) information with respect to how the Secretary 
                of Defense is implementing the changes identified in 
                the report submitted under paragraph (1); and
                    (C) information with respect to any steps described 
                in subparagraph (B) of such paragraph that were taken 
                by States and local communities after the date on which 
                such report was submitted.
    (g) Termination.--The working group shall terminate on the date 
that is 30 days after the date on which the working group submits the 
final report pursuant to subsection (f)(2).
    (h) Definitions.--In this Act:
            (1) The term ``children'' means dependents of a member of 
        the Armed Forces who are--
                    (A) individuals who have not yet attained the age 
                of 21; or
                    (B) individuals who have not yet attained the age 
                of 27 if the inclusion of such dependents is applicable 
                and relevant to a program or policy being reviewed 
                under this Act.
            (2) The term ``congressional defense committees'' has the 
        meaning given that term in section 101(a)(16) of title 10, 
        United States Code.
            (3) The term ``ECHO program'' means the program established 
        pursuant to subsections (d) through (e) of section 1079 of 
        title 10, United States Code (commonly referred to as the 
        ``Extended Care Health Option program'').
            (4) The term ``TRICARE program'' means the managed health 
        care program that is established by the Department of Defense 
        under chapter 55 of title 10, United States Code.
                                 <all>
```