I 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SENSE OF CONGRESS. 

4 It is the sense of Congress that— 

5 (1) children of members of the Armed Forces 

6 deserve health-care practices and policies that— 

7 (A) are designed to meet their pediatric8 specific needs; 


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1 (B) are developed and determined 

2 proactively and comprehensively; and 

3 (C) ensure and maintain their access to pe4 diatric-specific treatments, providers, and facili5 ties; 

6 (2) children’s health-care needs and standards 

7 of care are different and distinct from those of 

8 adults, therefore the TRICARE program should un9 dertake a proactive, comprehensive approach to re10 view and analyze its policies and practices to meet 

11 the needs of children to ensure that children and 

12 their families receive appropriate care in proper set13 tings and avoid unnecessary challenges in seeking or 

14 obtaining proper health care; 

15 (3) a proactive and comprehensive review is 

16 necessary because the reimbursement structure of 

17 the TRICARE program is patterned upon Medicare 

18 and the resulting policies and practices of the 

19 TRICARE program do not always properly reflect 

20 appropriate standards for pediatric care; 

21 (4) one distinct aspect of children’s health care 

22 is the need for specialty care and services for chil23 dren with special-health-care needs and chronic24 health conditions; 


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1 (5) the requirement for specialized health care 

2 and developmental support is an ongoing and serious 

3 matter of day-to-day life for families with children 

4 with special or chronic-health-care needs; 

5 (6) the Department of Defense and the 

6 TRICARE program, recognizing the special needs of 

7 certain children, have instituted special-needs pro8 grams, including the ECHO program, but there are 

9 collateral needs that are not being met, generally be10 cause the services are provided in the local commu11 nity rather than by the Department of Defense, who 

12 may not always have the best tools or knowledge to 

13 access these State and local resources; 

14 (7) despite wholehearted efforts by the Depart15 ment of Defense, a gap exists between linking mili16 tary families with children with special-health-care 

17 needs and chronic conditions with the resources and 

18 services available from local or regional highly spe19 cialized providers and the communities and States in 

20 which they reside; 

21 (8) the gap is especially exacerbated by the mo22 bility of military families, who often move from 

23 State to State, because special-needs health care, 

24 educational, and social services are very specific to 


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1 each local community and State and such services 

2 often have lengthy waiting lists; and 

3 (9) the Department of Defense will be better 

4 able to assist military families with children with 

5 special-health-care needs fill the gap by collaborating 

6 with special-health-care needs providers and those 

7 knowledgeable about the opportunities for such chil8 dren that are provided by States and local commu9 nities. 

10 SEC. 2. ESTABLISHMENT OF TRICARE WORKING GROUP. 

11 (a) ESTABLISHMENT.— 

12 (1) IN GENERAL.—The Secretary of Defense 

13 shall establish a working group to carry out a review 

14 of the TRICARE program with respect to— 

15 (A) pediatric health care needs under para16 graph (2); and 

17 (B) pediatric special and chronic health 

18 care needs under paragraph (3). 

19 (2) PEDIATRIC HEALTH CARE NEEDS.— 

20 (A) DUTIES.—The working group shall— 

21 (i) comprehensively review the policy 

22 and practices of the TRICARE program 

23 with respect to providing pediatric health 

24 care; 


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1 (ii) recommend changes to such poli2 cies and practices to ensure that— 

3 (I) children receive appropriate 

4 care in an appropriate manner, at the 

5 appropriate time, and in an appro6 priate setting; and 

7 (II) access to care and treatment 

8 provided by pediatric providers and 

9 children’s hospitals remains available 

10 for families with children; and 

11 (iii) develop a plan to implement such 

12 changes. 

13 (B) REVIEW.—In carrying out the duties 

14 under subparagraph (A), the working group 

15 shall— 

16 (i) identify improvements in policies, 

17 practices, and administration of the 

18 TRICARE program with respect to pedi19 atric-specific health care and pediatric-spe20 cific healthcare settings; 

21 (ii) analyze the direct and indirect ef22 fects of the reimbursement policies and 

23 practices of the TRICARE program with 

24 respect to pediatric care and care provided 

25 in pediatric settings; 


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1 (iii) consider case management pro2 grams with respect to pediatric complex 

3 and chronic care, including whether pedi4 atric specific programs are necessary; 

5 (iv) develop a plan to ensure that the 

6 TRICARE program addresses pediatric7 specific health care needs on an on-going 

8 basis beyond the life of the working group; 

9 (v) consider how the TRICARE pro10 gram can work with the pediatric provider 

11 community to ensure access, promote com12 munication and collaboration, and optimize 

13 experiences of military families seeking and 

14 receiving health care services for children; 

15 and 

16 (vi) review matters that further the 

17 mission of the working group. 

18 (3) PEDIATRIC SPECIAL AND CHRONIC HEALTH

19 CARE NEEDS.— 

20 (A) DUTIES.—The working group shall— 

21 (i) review the methods in which fami22 lies in the TRICARE program who have 

23 children with special-health-care needs ac24 cess community resources and health-care 

25 resources; 


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1 (ii) review how having access to, and 

2 a better understanding of, community re3 sources may improve access to health care 

4 and support services; 

5 (iii) recommend methods to accom6 plish improved access by such children and 

7 families to community resources and 

8 health-care resources, including through 

9 collaboration with children’s hospitals and 

10 other providers of pediatric specialty care, 

11 local agencies, local communities, and 

12 States; 

13 (iv) consider approaches and make 

14 recommendations for the improved integra15 tion of individualized or compartmentalized 

16 medical and family support resources for 

17 military families; 

18 (v) work closely with the Office of 

19 Community Support for Military Families 

20 with Special Needs of the Department of 

21 Defense and other relevant offices to avoid 

22 redundancies and target shared areas of 

23 concern for children with special or chron24 ic-health-care needs; and 


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1 (vi) review any relevant information 

2 learned and findings made by the working 

3 group under this paragraph that may be 

4 considered or adopted in a consistent man5 ner with respect to improving access, re6 sources, and services for adults with spe7 cial needs. 

8 (B) REVIEW.—In carrying out the duties 

9 under subparagraph (A), the working group 

10 shall— 

11 (i) discuss improvements to special 

12 needs health care policies and practices; 

13 (ii) determine how to support and pro14 tect families of members of the National 

15 Guard or Reserve Components as the 

16 members transition into and out of the rel17 evant Exceptional Family Member Pro18 gram or the ECHO program; 

19 (iii) analyze case management services 

20 to improve consistency, communication, 

21 knowledge, and understanding of resources 

22 and community contacts; 

23 (iv) identify areas in which a State 

24 may offer services that are not covered by 


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1 the TRICARE program or the ECHO pro2 gram and how to coordinate such services; 

3 (v) identify steps that States and 

4 communities can take to improve support 

5 for military families of children with spe6 cial health care needs; 

7 (vi) consider how the TRICARE pro8 gram and other programs of the Depart9 ment of Defense can work with specialty 

10 pediatric providers and resource commu11 nities to ensure access, promote commu12 nication and collaboration, and optimize 

13 experiences of military families seeking and 

14 receiving health care services for their chil15 dren with special or chronic health care 

16 needs; 

17 (vii) consider special and chronic 

18 health care in a comprehensive manner 

19 without focus on one or more conditions or 

20 diagnoses to the exclusion of others; 

21 (viii) focus on ways to create innova22 tive partnerships, linkages, and access to 

23 information and resources for military 

24 families across the spectrum of the special25 needs community and between the medical 


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1 community and the family support commu2 nity; and 

3 (ix) review matters that further the 

4 mission of the working group. 

5 (b) MEMBERSHIP.— 

6 (1) APPOINTMENTS.—The working group shall 

7 be composed of not less than 14 members as follows: 

8 (A) The Chief Medical Officer of the 

9 TRICARE program, who shall serve as chair10 person. 

11 (B) The Chief Medical Officers of the 

12 North, South, and West regional offices of the 

13 TRICARE program. 

14 (C) One individual representing the Army 

15 appointed by the Surgeon General of the Army. 

16 (D) One individual representing the Navy 

17 appointed by the Surgeon General of the Navy. 

18 (E) One individual representing the Air 

19 Force appointed by the Surgeon General of the 

20 Air Force. 

21 (F) One individual representing the re22 gional managed care support contractor of the 

23 North region of the TRICARE program ap24 pointed by such contractor. 


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1 (G) One individual representing the re2 gional managed care support contractor of the 

3 South region of the TRICARE program ap4 pointed by such contractor. 

5 (H) One individual representing the re6 gional managed care support contractor of the 

7 West region of the TRICARE program ap8 pointed by such contractor. 

9 (I) Not more than three individuals rep10 resenting the non-profit organization the Mili11 tary Coalition appointed by such organization. 

12 (J) One individual representing the Amer13 ican Academy of Pediatrics appointed by such 

14 organization. 

15 (K) One individual representing the Na16 tional Association of Children’s Hospitals ap17 pointed by such organization. 

18 (L) One individual representing military 

19 families who is not an employee of an organiza20 tion representing such families. 

21 (M) Any other individual as determined by 

22 the Chief Medical Officer of the TRICARE pro23 gram. 

24 (2) TERMS.—Each member shall be appointed 

25 for the life of the working group. A vacancy in the 


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1 working group shall be filled in the manner in which 

2 the original appointment was made. 

3 (3) TRAVEL EXPENSES.—Each member shall 

4 receive travel expenses, including per diem in lieu of 

5 subsistence, in accordance with applicable provisions 

6 under subchapter I of chapter 57 of title 5, United 

7 States Code. 

8 (4) STAFF.—The Secretary of Defense shall en9 sure that employees of the TRICARE program pro10 vide the working group with the necessary support 

11 to carry out this section. 

12 (c) MEETINGS.— 

13 (1) SCHEDULE.—The working group shall— 

14 (A) convene its first meeting not later than 

15 60 days after the date of the enactment of this 

16 Act; and 

17 (B) convene not less than four other times. 

18 (2) FORM.—Any meeting of the working group 

19 may be conducted in-person or through the use of 

20 video conferencing. 

21 (3) QUORUM.—Seven members of the working 

22 group shall constitute a quorum but a lesser number 

23 may hold hearings. 

24 (d) POWERS.— 


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1 (1) HEARINGS AND TESTIMONY.—The working 

2 group may, for the purpose of carrying out this Act, 

3 hold public or private hearings, sit and act at times 

4 and places, take written or oral comments or testi5 mony, and receive evidence as the working group 

6 considers appropriate. 

7 (2) OFFICIAL INFORMATION.—The working 

8 group may secure directly from any department or 

9 agency of the United States information necessary 

10 to enable it to carry out this Act. 

11 (3) MAILS.—The working group may use the 

12 United States mails in the same manner and under 

13 the same conditions as other departments and agen14 cies of the United States. 

15 (e) CONSULTATION.— 

16 (1) ADVICE.—With respect to carrying out the 

17 review of the TRICARE program and pediatric spe18 cial and chronic health care needs under subsection 

19 (a)(3), the working group shall seek counsel from 

20 the following individuals acting as an expert advisory 

21 group: 

22 (A) One individual representing the Excep23 tional Family Member Program of the Army. 

24 (B) One individual representing the Excep25 tional Family Member Program of the Navy. 


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1 (C) One individual representing the Excep2 tional Family Member Program of the Air 

3 Force. 

4 (D) One individual representing the Excep5 tional Family Member Program of the Marine 

6 Corps. 

7 (E) One individual representing the Office 

8 of Community Support for Military Families 

9 with Special Needs. 

10 (F) One individual who is not an employee 

11 of an organization representing military families 

12 shall represent a military family with a child 

13 with special health care needs. 

14 (G) Not more than three individuals rep15 resenting organizations that— 

16 (i) are not otherwise represented in 

17 this paragraph or in the working group; 

18 and 

19 (ii) possess expertise needed to carry 

20 out the goals of the working group. 

21 (2) COMMENTS.—With respect to carrying out 

22 the review of the TRICARE program and pediatric 

23 special and chronic health care needs under sub24 section (a)(3), the working group shall invite and ac25 cept comments and testimony from States, local 


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1 communities, national special needs advocacy 

2 groups, educators, pediatric-health-care providers, 

3 and military family advocates. 

4 (f) REPORTS REQUIRED.— 

5 (1) REPORT.—Not later than 12 months after 

6 the date on which the working group convenes its 

7 first meeting, the working group shall submit to the 

8 congressional defense committees a report includ9 ing— 

10 (A) any changes described in subsection 

11 (a)(2)(A)(ii) identified by the working group 

12 that— 

13 (i) require legislation to carry out, in14 cluding proposed legislative language for 

15 such changes; 

16 (ii) require regulations to carry out, 

17 including proposed regulatory language for 

18 such changes; and 

19 (iii) may be carried out without legis20 lation or regulations, including a time line 

21 for such changes; and 

22 (B) steps that States and local commu23 nities may take to improve the experiences of 

24 military families with special-needs children in 


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1 interacting with and accessing State and local 

2 community resources. 

3 (2) FINAL REPORT.—Not later than 18 months 

4 after the date on which the report is submitted 

5 under paragraph (1), the working group shall sub6 mit to the congressional defense committees a final 

7 report including— 

8 (A) any additional information and up9 dates to the report submitted under paragraph 

10 (1); 

11 (B) information with respect to how the 

12 Secretary of Defense is implementing the 

13 changes identified in the report submitted 

14 under paragraph (1); and 

15 (C) information with respect to any steps 

16 described in subparagraph (B) of such para17 graph that were taken by States and local com18 munities after the date on which such report 

19 was submitted. 

20 (g) TERMINATION.—The working group shall termi21 nate on the date that is 30 days after the date on which 

22 the working group submits the final report pursuant to 

23 subsection (f)(2). 

24 (h) DEFINITIONS.—In this Act: 


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1 (1) The term ‘‘children’’ means dependents of a 

2 member of the Armed Forces who are— 

3 (A) individuals who have not yet attained 

4 the age of 21; or 

5 (B) individuals who have not yet attained 

6 the age of 27 if the inclusion of such depend7 ents is applicable and relevant to a program or 

8 policy being reviewed under this Act. 

9 (2) The term ‘‘congressional defense commit10 tees’’ has the meaning given that term in section 

11 101(a)(16) of title 10, United States Code. 

12 (3) The term ‘‘ECHO program’’ means the pro13 gram established pursuant to subsections (d) 

14 through (e) of section 1079 of title 10, United 

15 States Code (commonly referred to as the ‘‘Extended 

16 Care Health Option program’’). 

17 (4) The term ‘‘TRICARE program’’ means the 

18 managed health care program that is established by 

19 the Department of Defense under chapter 55 of title 

20 10, United States Code. 

Æ 


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