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) in-
troduced 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 pro-
viding health care to children and determine how to 
improve such policy, 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. 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; 
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(B) 
are 
developed 
and 
determined 
proactively and comprehensively; and 
(C) ensure and maintain their access to pe-
diatric-specific treatments, providers, and facili-
ties; 
(2) children’s health-care needs and standards 
of care are different and distinct from those of 
adults, therefore the TRICARE program should un-
dertake a proactive, comprehensive approach to re-
view and analyze its policies and practices to meet 
the needs of children to ensure that children and 
their families receive appropriate care in proper set-
tings 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 chil-
dren with special-health-care needs and chronic- 
health conditions; 
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(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 pro-
grams, including the ECHO program, but there are 
collateral needs that are not being met, generally be-
cause the services are provided in the local commu-
nity 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 Depart-
ment of Defense, a gap exists between linking mili-
tary families with children with special-health-care 
needs and chronic conditions with the resources and 
services available from local or regional highly spe-
cialized providers and the communities and States in 
which they reside; 
(8) the gap is especially exacerbated by the mo-
bility of military families, who often move from 
State to State, because special-needs health care, 
educational, and social services are very specific to 
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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 chil-
dren that are provided by States and local commu-
nities. 
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 para-
graph (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; 
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(ii) recommend changes to such poli-
cies and practices to ensure that— 
(I) children receive appropriate 
care in an appropriate manner, at the 
appropriate time, and in an appro-
priate 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 pedi-
atric-specific health care and pediatric-spe-
cific healthcare settings; 
(ii) analyze the direct and indirect ef-
fects of the reimbursement policies and 
practices of the TRICARE program with 
respect to pediatric care and care provided 
in pediatric settings; 
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(iii) consider case management pro-
grams with respect to pediatric complex 
and chronic care, including whether pedi-
atric 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 pro-
gram can work with the pediatric provider 
community to ensure access, promote com-
munication 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 fami-
lies in the TRICARE program who have 
children with special-health-care needs ac-
cess community resources and health-care 
resources; 
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(ii) review how having access to, and 
a better understanding of, community re-
sources may improve access to health care 
and support services; 
(iii) recommend methods to accom-
plish 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 integra-
tion 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 chron-
ic-health-care needs; and 
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(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 man-
ner with respect to improving access, re-
sources, and services for adults with spe-
cial 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 pro-
tect families of members of the National 
Guard or Reserve Components as the 
members transition into and out of the rel-
evant Exceptional Family Member Pro-
gram 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 
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the TRICARE program or the ECHO pro-
gram and how to coordinate such services; 
(v) identify steps that States and 
communities can take to improve support 
for military families of children with spe-
cial health care needs; 
(vi) consider how the TRICARE pro-
gram and other programs of the Depart-
ment of Defense can work with specialty 
pediatric providers and resource commu-
nities to ensure access, promote commu-
nication and collaboration, and optimize 
experiences of military families seeking and 
receiving health care services for their chil-
dren 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 innova-
tive partnerships, linkages, and access to 
information and resources for military 
families across the spectrum of the special- 
needs community and between the medical 
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community and the family support commu-
nity; 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 chair-
person. 
(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 re-
gional managed care support contractor of the 
North region of the TRICARE program ap-
pointed by such contractor. 
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(G) One individual representing the re-
gional managed care support contractor of the 
South region of the TRICARE program ap-
pointed by such contractor. 
(H) One individual representing the re-
gional managed care support contractor of the 
West region of the TRICARE program ap-
pointed by such contractor. 
(I) Not more than three individuals rep-
resenting the non-profit organization the Mili-
tary Coalition appointed by such organization. 
(J) One individual representing the Amer-
ican Academy of Pediatrics appointed by such 
organization. 
(K) One individual representing the Na-
tional Association of Children’s Hospitals ap-
pointed by such organization. 
(L) One individual representing military 
families who is not an employee of an organiza-
tion representing such families. 
(M) Any other individual as determined by 
the Chief Medical Officer of the TRICARE pro-
gram. 
(2) TERMS.—Each member shall be appointed 
for the life of the working group. A vacancy in the 
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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 en-
sure that employees of the TRICARE program pro-
vide 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.— 
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(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 testi-
mony, 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 agen-
cies of the United States. 
(e) CONSULTATION.— 
(1) ADVICE.—With respect to carrying out the 
review of the TRICARE program and pediatric spe-
cial 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 Excep-
tional Family Member Program of the Army. 
(B) One individual representing the Excep-
tional Family Member Program of the Navy. 
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(C) One individual representing the Excep-
tional Family Member Program of the Air 
Force. 
(D) One individual representing the Excep-
tional 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 rep-
resenting 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 sub-
section (a)(3), the working group shall invite and ac-
cept comments and testimony from States, local 
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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 includ-
ing— 
(A) any changes described in subsection 
(a)(2)(A)(ii) identified by the working group 
that— 
(i) require legislation to carry out, in-
cluding 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 legis-
lation or regulations, including a time line 
for such changes; and 
(B) steps that States and local commu-
nities may take to improve the experiences of 
military families with special-needs children in 
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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 sub-
mit to the congressional defense committees a final 
report including— 
(A) any additional information and up-
dates 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 para-
graph that were taken by States and local com-
munities after the date on which such report 
was submitted. 
(g) TERMINATION.—The working group shall termi-
nate 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: 
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(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 depend-
ents is applicable and relevant to a program or 
policy being reviewed under this Act. 
(2) The term ‘‘congressional defense commit-
tees’’ has the meaning given that term in section 
101(a)(16) of title 10, United States Code. 
(3) The term ‘‘ECHO program’’ means the pro-
gram 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. 
Æ 
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