I
107TH CONGRESS
1ST SESSION
H. R. 2987
To amend title 10, United States Code, to fully integrate the beneficiaries
of the Individual Case Management Program into the TRICARE pro-
gram, to provide long-term health care benefits under the TRICARE
program and otherwise to improve the benefits provided under the
TRICARE program, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
OCTOBER 2, 2001
Mr. CAPUANO introduced the following bill; which was referred to the
Committee on Armed Services
A BILL
To amend title 10, United States Code, to fully integrate
the beneficiaries of the Individual Case Management Pro-
gram into the TRICARE program, to provide long-term
health care benefits under the TRICARE program and
otherwise to improve the benefits provided under the
TRICARE program, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘TRICARE Benefits
Modernization Act of 2001’’.
TITLE I—INTEGRATION OF INDI-
VIDUAL CASE MANAGEMENT
PROGRAM 
BENEFITS 
AND
TRICARE BASIC BENEFITS
SEC. 101. REQUIREMENT FOR INTEGRATION OF BENEFITS.
(a) IN GENERAL.—The Secretary of Defense shall—
(1) terminate the Individual Case Management
Program carried out under section 1079(a)(17) of
title 10, United States Code (as in effect on the day
before the effective date specified in section 401);
and
(2) integrate the beneficiaries under that pro-
gram, and the furnishing of care to those bene-
ficiaries, into the TRICARE program as modified
pursuant to the amendments made by this title.
(b) REPEAL
OF SEPARATE AUTHORITY.—Section
1079 of title 10, United States Code, is amended by strik-
ing paragraph (17).
(c) SAVINGS PROVISION.—Nothing in this Act title
or the amendments made by this Act shall be construed—
(1) to modify any eligibility requirement for any
person receiving benefits under the Individual Case
Management Program before the effective date spec-
ified in section 401; or
(2) to terminate any benefits available under
that program before that date.
(d) CONSULTATION REQUIREMENT.—The Secretary
of Defense shall consult with the other administering Sec-
retaries referred to in section 1072(3) of title 10, United
States Code, in carrying out this subsection.
SEC. 102. DOMICILIARY AND CUSTODIAL CARE INCIDENT
TO MEDICAL CARE.
(a) AUTHORITY.—Section 1077 of title 10, United
States Code, is amended—
(1) in subsection (b)(1), by inserting before the
period end the following: ‘‘, except as provided in
subsection (e)’’; and
(2) by adding at the end the following new sub-
section:
‘‘(e) The prohibition in subsection (b)(1) does not
apply to domiciliary care or custodial care that is provided
to a patient by a physician, nurse, paramedic, or other
health care provider incident to other health care author-
ized under subsection (a), whether or not—
‘‘(1) the potential for the patient’s condition of
illness, injury, or bodily malfunction to improve
might be nonexistent or minimal; or
‘‘(2) the care is provided for the purposes of
maintaining function and preventing deterioration.’’.
(b) DOMICILIARY
AND
CUSTODIAL
CARE
DE-
FINED.—Section 1072 of title 10, United States Code, is
amended by adding at the end the following new para-
graphs:
‘‘(8) The term ‘domiciliary care’ means treat-
ment or services involving assistance with the per-
formance of activities of daily living that is provided
to a patient in a home-like setting because—
‘‘(A) the treatment or services are not
available, or are not suitable to be provided, to
the patient in the patient’s home; or
‘‘(B) no member of the patient’s family is
willing to provide the treatment or services.
‘‘(9) The term ‘custodial care’—
‘‘(A) means treatment or services that—
‘‘(i) could be provided safely and rea-
sonably by a person not trained as a physi-
cian, nurse, paramedic, or other health
care provider; or
‘‘(ii) are provided principally to assist
the recipient of the treatment or services
with the performance of activities of daily
living; and
‘‘(B) includes any treatment or service de-
scribed in subparagraph (A) without regard
to—
‘‘(i) the source of any recommenda-
tion to provide the treatment or service;
and
‘‘(ii) the setting in which the treat-
ment or service is provided.’’.
SEC. 103. CONFORMING REPEALS.
The following provisions of law are repealed:
(1) Section 703 of the National Defense Au-
thorization Act for Fiscal Year 2000 (Public Law
106–65; 113 Stat. 682; 10 U.S.C. 1077 note).
(2) Section 8118 of the Department of Defense
Appropriation Act, 2000 (Public Law 106–79; 113
Stat. 1260).
(3) Section 8100 of the Department of Defense
Appropriation Act, 2001 (Public Law 106–259; 114
Stat. 696).
TITLE II—LONG TERM HEALTH
BENEFITS
SEC. 201. LONG TERM CARE.
(a) LIMITATION.—Chapter 55 of title 10, United
States Code, is amended by inserting after section 1074i
the following new section:
‘‘§ 1074j. Long term care benefits program
‘‘(a) REQUIREMENT FOR PROGRAM.—The Secretary
of Defense shall provide long term health care benefits
under the TRICARE program in an effective and efficient
manner that integrates those benefits with the benefits
provided on a less than a long term basis under the
TRICARE program.
‘‘(b) AUTHORIZED CARE.—The types of health care
authorized to be provided under this section shall include
the following:
‘‘(1) The types of health care authorized to be
acquired by contract under section 1079 of this title.
‘‘(2) Extended care services.
‘‘(3) Post-hospital extended care services.
‘‘(4) Comprehensive intermittent home health
services.
‘‘(c) DURATION
OF
POST-HOSPITAL
EXTENDED
CARE SERVICES.—The post-hospital extended care serv-
ices provided in a skilled nursing facility to a patient dur-
ing a spell of illness under subsection (b)(3) shall continue
for as long as is medically necessary and appropriate. The
limitation on the number of days of coverage under sub-
sections (a)(2) and (b)(2)(A) of section 1812 of the Social
Security Act (42 U.S.C. 1395d) shall not apply with re-
spect to the care provided that patient.
‘‘(d) REGULATIONS.—The Secretary of Defense shall,
after consultation with the other administering Secre-
taries, prescribe regulations to carry out this section.
‘‘(e) DEFINITIONS.—In this section:
‘‘(1) The term ‘extended care services’ has the
meaning given the term in subsection (h) of section
1861 of the Social Security Act (42 U.S.C. 1395x).
‘‘(2) The term ‘post-hospital extended services’
has the meaning given the term in subsection (i) of
section 1861 of the Social Security Act (42 U.S.C.
1395x).
‘‘(3) The term ‘home health services’ has the
meaning given the term in section 1861(m) of the
Social Security Act (42 U.S.C. 1395x(m)).
‘‘(4) The term ‘skilled nursing facility’ has the
meaning given the term in section 1819(a) of the
Social Security Act (42 U.S.C. 1395i–3(a)).
‘‘(5) The term ‘spell of illness’ has the meaning
given the term in section 1861(a) of the Social Secu-
rity Act (42 U.S.C. 1395x(a)).’’.
(b) CLERICAL AMENDMENT.—The table of sections
at the beginning of such chapter is amended by inserting
after the item relating to section 1074i the following new
item:
‘‘1074j. Long term care benefits program.’’.
SEC. 202. EXTENDED BENEFITS FOR DISABLED BENE-
FICIARIES.
Section 1079 of title 10, United States Code, is
amended by striking subsections (d), (e), and (f) and in-
serting the following:
‘‘(d)(1) The health care benefits contracted for under
this section shall include extended benefits for dependents
referred to in the first sentence of subsection (a) who have
any of the following qualifying conditions:
‘‘(A) Moderate or severe mental retardation.
‘‘(B) A serious physical disability.
‘‘(C) Any extraordinary physical or psycho-
logical condition.
‘‘(2) The extended benefits shall include comprehen-
sive health care and case management services, to the ex-
tent not otherwise provided under this chapter with re-
spect to a qualifying condition, as follows:
‘‘(A) Diagnosis.
‘‘(B) Inpatient, outpatient, and comprehensive
home health supplies and services.
‘‘(C) Training and rehabilitation, including spe-
cial education and assistive technology devices.
‘‘(D) Institutional care in private nonprofit,
public, and State institutions and facilities and,
when appropriate, transportation to and from such
institutions and facilities.
‘‘(E) Any other services and supplies deter-
mined appropriate under regulations prescribed
under paragraph (6).
‘‘(3) The extended benefits shall also include respite
care for the primary caregiver of a dependent eligible for
extended benefits under this subsection.
‘‘(4) Home health supplies and services may be pro-
vided to a dependent under paragraph (2)(B) as other
than part-time or intermittent services (as determined in
accordance with the second sentence of section 1861(m)
of the Social Security Act (42 U.S.C. 1395x(m)) only if—
‘‘(A) the provision of such supplies and services
in the home of the dependent is medically appro-
priate; and
‘‘(B) the cost of the provision of such supplies
and services to the dependent is equal to or less
than the cost of the provision of similar supplies and
services to the dependent in a skilled nursing facil-
ity.
‘‘(5) Subsection (a)(13) shall not apply to the provi-
sion of care and services determined appropriate to be pro-
vided as extended benefits under this subsection.
‘‘(6) A member of the uniformed services shall pay
a share of the cost of any care and services provided as
extended benefits to any of the dependents of the member
under this subsection as follows:
‘‘(A) In the case of a member in the lowest en-
listed pay grade, the first $25 of the cumulative
costs of all care furnished to one or more dependents
of the member in a month.
‘‘(B) In the case of a member in the highest
commissioned pay grade, the first $250 of the cumu-
lative costs of all care furnished to one or more de-
pendents of the member in a month.
‘‘(C) In the case of a member in any other pay
grade, a fixed amount of the cumulative costs of all
care furnished to one or more dependents of the
member in a month, as prescribed for that pay
grade in regulations prescribed under paragraph (6).
‘‘(7) The Secretary of Defense, in consultation with
the other administering Secretaries, shall prescribe regula-
tions to carry out this subsection.’’.
SEC. 203. REPORT TO CONGRESS ON RELATIONSHIP
AMONG FEDERAL LONG-TERM CARE INITIA-
TIVES.
Not later than April 1, 2002, the Secretary of De-
fense shall submit to Congress a report on the relationship
and compatibility of the long term care insurance program
under chapter 90 of title 5, United States Code (as added
by the Federal Long-Term Care Security Act), and other
initiatives of the Federal Government to provide long term
care benefits for which members of the uniformed services
and their dependents are or would be eligible.
TITLE 
III—IMPROVEMENTS 
IN
TRICARE 
BASIC 
BENEFITS
AND 
ADMINISTRATION 
OF
BENEFITS
SEC. 301. SERVICES OR SUPPLIES DETERMINED NEC-
ESSARY.
(a) DETERMINATIONS
OF NECESSITY.—Subsection
(a)(13) of section 1079 of title 10, United States Code,
is amended—
(1) by inserting ‘‘(A)’’ after ‘‘(13)’’;
(2) by designating the second sentence as sub-
paragraph (C), realigning that subparagraph flush
to the left margin, and striking ‘‘this paragraph’’ in
the text of such subparagraph (as so redesignated)
and inserting ‘‘subparagraph (A)’’; and
(3) by inserting after subparagraph (A), as des-
ignated by subparagraph (A), the following new sub-
paragraph:
‘‘(B) For the purposes of subparagraph (A), the de-
termination that a service or supply is medically or psy-
chologically necessary to prevent, diagnose, or treat a
mental or physical illness, injury, or bodily malfunction of
a patient, or to prevent deterioration of a patient, when
made by the physician treating the patient, shall be con-
clusive unless the physician’s determination is clearly erro-
neous, as determined by a higher authority or under the
CHAMPUS Peer Review Organization program.’’.
(b) DETERMINATIONS NOT SUBJECT TO PEER RE-
VIEW.—Subsection (o)(1) of such section is amended by
inserting ‘‘(subject to subsection (a)(13)(B))’’ after ‘‘de-
termined’’.
SEC. 302. PROSTHETICS, ORTHOTICS, AND HEARING AIDS.
Section 1077 of title 10 United States Code, as
amended by section 102, is further amended—
(1) in subsection (a), by striking paragraph
(15) and inserting the following:
‘‘(15) A prosthetic or orthotic device, together
with related items and services as provided in sub-
section (e).
‘‘(16) A hearing aid, but only for a dependent
of a member of the uniformed services on active
duty and only if the dependent has a profound hear-
ing loss, as determined under standards prescribed
in regulations by the Secretary of Defense in con-
sultation with the administering Secretaries.’’;
(2) in subsection (b)(2), by striking ‘‘Hearing
aids, orthopedic footwear,’’ and inserting ‘‘Ortho-
pedic footwear’’; and
(3) by adding at the end the following new sub-
section:
‘‘(f)(1) Authority to provide a prosthetic or orthotic
device under subsection (a)(15) includes authority to pro-
vide 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 func-
tioning.
‘‘(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.
‘‘(E) Replacement of an orthotic device when
appropriate to accommodate the patient’s growth or
change of condition.
‘‘(2) An augmentative communication device may be
provided as a voice prosthesis under subsection (a)(15).
‘‘(3) A prosthetic or orthotic device customized for
a patient may be provided under this section only by a
prosthetic or orthotic practitioner, respectively, who is
qualified to customize the device, as determined under reg-
ulations prescribed by the Secretary of Defense in con-
sultation with the administering Secretaries.’’.
SEC. 303. DURABLE MEDICAL EQUIPMENT.
(a) ITEMS AUTHORIZED.—Section 1077 of title 10,
United States Code, as amended by section 302, is further
amended—
(1) in subsection (a)(12), by striking ‘‘such as
wheelchairs, iron lungs, and hospital beds,’’ and in-
serting ‘‘which’’; and
(2) by adding at the end the following new sub-
section:
‘‘(g)(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 mal-
formed, diseased, or injured body part, or can other-
wise minimize or prevent the deterioration of the pa-
tient’s function or condition.
‘‘(B) Any durable medical equipment that can
maximize the patient’s function and mobility con-
sistent 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 pa-
tient;
‘‘(B) making the equipment serviceable; or
‘‘(C) otherwise assuring the proper functioning
of the equipment.
‘‘(3) The eligibility of a patient to receive durable
medical equipment and related services under this section
or section 1079(a)(5) of this title may not be limited on
the basis that a primary purpose of the use of the equip-
ment by the patient is transportation, comfort, or conven-
ience of the patient.’’.
(b) PROVISION OF ITEMS ON RENTAL BASIS.—Para-
graph (5) of section 1079(a) of such title is amended to
read as follows:
‘‘(5) Durable equipment provided under this
section shall be provided on a rental basis.’’.
SEC. 304. REHABILITATIVE THERAPY.
Section 1077(a) of title 10, United States Code, as
amended by section 302(1), is further amended by insert-
ing after paragraph (16) the following new paragraph:
‘‘(17) Any rehabilitative therapy to improve, re-
store, or maintain function, or to minimize or pre-
vent deterioration of function, of a patient when pre-
scribed by a physician, including the following thera-
pies:
‘‘(A) Physical or occupational therapy to
maintain range of motion in a paralyzed ex-
tremity of the patient, without regard to wheth-
er a purpose for providing the therapy is to re-
store a specific loss of function or is related to
the restoration of a specific loss of function.
‘‘(B) Occupational therapy for an amputee
or a patient with an orthopedic impairment, in-
cluding gait analysis.
‘‘(C) Respiratory or recreation therapy
that is included as part of a treatment plan es-
tablished for the patient by the physician.’’.
SEC. 305. MENTAL HEALTH BENEFITS.
Section 1079(i) of title 10, United States Code, is
amended by adding at the end the following new para-
graphs:
‘‘(4)(A) To receive outpatient mental health services
under a contract entered into under this section or section
1086 of this title for periods in excess of a limitation on
the availability of outpatient mental health benefit for a
year under the contract, a person may convert any unused
period of inpatient mental health benefit available to the
person for that year under the contract to one or more
additional periods of availability of outpatient mental
health benefit.
‘‘(B) The total amount of inpatient mental health
benefit remaining available to a person for a year under
a contract referred to in subparagraph (A) shall be re-
duced to the extent of any conversion of the benefit for
the person for the year under that subparagraph.
‘‘(C) For the purposes of this paragraph, one day of
inpatient mental health benefit converts to eight hours of
outpatient mental health benefit.
‘‘(5) Mental health services, including substance
abuse services, available to a patient under a contract en-
tered into under this section or section 1086 of this title
shall be furnished to the patient in the least restrictive
environment that is effective and appropriate for meeting
the treatment and rehabilitative needs of the patient.’’.
TITLE IV—EFFECTIVE DATE
SEC. 401. EFFECTIVE DATE.
This Act and the amendments made by this Act shall
take effect on October 1, 2001.
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