I 
116TH CONGRESS 
2D SESSION 
H. R. 6148 
To amend title 10, United States Code, to expand benefits available under 
the TRICARE Extended Health Care Option program, and for other 
purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 9, 2020 
Mr. COLE (for himself and Mrs. LURIA) introduced the following bill; which 
was referred to the Committee on Armed Services 
A BILL 
To amend title 10, United States Code, to expand benefits 
available under the TRICARE Extended Health Care 
Option 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 ECHO Im-
provement Act’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Active duty members of the uniformed serv-
ices encounter difficulties accessing Home and Com-
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munity-Based Services (HCBS) waivers under Med-
icaid for the dependents of such members who have 
intellectual or developmental disabilities. 
(2) State residency requirements create barriers 
to accessing such benefits for military families who 
move across State lines and are required to reenroll 
with each permanent change of station. 
(3) Enrollment caps for such waivers create ad-
ditional barriers, and often result in waiting lists 
due to the demand for such waivers, including, in 
2017, an average 30-month wait time. 
(4) The Military Compensation and Retirement 
Modernization Commission concluded that ‘‘access to 
HCBS waiver benefits is a substantial issue for mili-
tary families . . . Service members are required to 
re-apply for benefits each time they move to a new 
state. Many Service members encounter waiting lists 
that exceed their time assigned to a location.’’. 
(5) In 2001, the TRICARE Extended Care 
Health Option program (‘‘ECHO program’’) was es-
tablished as an alternative to HCBS waivers for 
military families. The ECHO program provides addi-
tional medical and non-medical services not covered 
by TRICARE to eligible military dependents with 
special needs, for the purpose of assisting in the re-
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duction of the disabling effects of the qualifying con-
dition of the dependent. 
(6) The Military Compensation and Retirement 
Modernization Commission concluded that, although 
ECHO was created as an alternative to HCBS waiv-
er benefits, ‘‘ECHO benefits, as currently imple-
mented, are not robust enough to replace state waiv-
er programs when those programs are inaccessible.’’ 
(7) Although the purpose of the ECHO pro-
gram is to provide supplemental services to depend-
ents with special needs, a 2014 study conducted by 
the Manpower Data Center of the Department of 
Defense found that only 37 percent of military fami-
lies that have a child with special needs were aware 
of the program. 
(8) The Conference Report accompanying the 
National Defense Authorization Act for Fiscal Year 
2010 stated that ‘‘expanding support for families 
with special needs is a critical requirement for the 
all-volunteer force.’’. 
SEC. 3. SENSE OF CONGRESS. 
It is the sense of Congress that military families de-
serve— 
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(1) equitable access to critical services that 
minimize the debilitating effects of a disabling condi-
tion; and 
(2) an evaluation of the effectiveness of current 
services under the ECHO program. 
SEC. 4. EXPANSION OF BENEFITS AVAILABLE UNDER 
TRICARE EXTENDED HEALTH CARE OPTION 
PROGRAM. 
(a) EXTENDED BENEFITS FOR ELIGIBLE DEPEND-
ENTS.—Subsection (e) of section 1079 of title 10, United 
States Code, is amended to read as follows: 
‘‘(e)(1) Extended benefits for eligible dependents 
under subsection (d) may include comprehensive health 
care services (including services necessary to maintain, or 
minimize or prevent deterioration of, function of the pa-
tient) and case management services with respect to the 
qualifying condition of such a dependent, and include, to 
the extent such benefits are not provided under provisions 
of this chapter other than under this section, the following: 
‘‘(A) Diagnosis and screening. 
‘‘(B) Inpatient, outpatient, and comprehensive 
home health care supplies and services which may 
include cost effective and medically appropriate serv-
ices other than part-time or intermittent services 
(within the meaning of such terms as used in the 
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second sentence of section 1861(m) of the Social Se-
curity Act). 
‘‘(C) Rehabilitation and habilitation services 
and devices. 
‘‘(D) Institutional care in private nonprofit, 
public, and State institutions and facilities and, if 
appropriate, transportation to and from such institu-
tions and facilities. 
‘‘(E) Custodial care, notwithstanding the prohi-
bition in section 1077(b)(1) of this title. 
‘‘(F) In accordance with paragraph (2), respite 
care for the primary caregiver of the eligible depend-
ent. 
‘‘(G) In accordance with paragraph (3), service 
and modification of durable equipment and assistive 
technology devices. 
‘‘(H) Special education. 
‘‘(I) Vocational training, which may be fur-
nished to an eligible dependent in the residence of 
the eligible dependent or at a facility in which such 
training is provided. 
‘‘(J) In accordance with paragraph (4), adapta-
tions to the private residence and vehicle of the eligi-
ble dependent. 
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SEC. 5. ADDITIONAL REQUIREMENTS IN OFFICE OF SPE-
CIAL NEEDS ANNUAL REPORT. 
Section 1781c(g)(2) of title 10, United States Code, 
is amended— 
(1) by redesignating subparagraph (C) as sub-
paragraph (D); and 
(2) by inserting after subparagraph (B) the fol-
lowing new subparagraph (C): 
‘‘(C) With respect to the Extended Care Health 
Option program under section 1079(d) of this title— 
‘‘(i) the utilization rates of services under 
such program by eligible dependents (as such 
term is defined in such section) during the prior 
year; 
‘‘(ii) a description of gaps in such services, 
as ascertained by the Secretary from informa-
tion provided by families of eligible dependents; 
‘‘(iii) an assessment of factors that prevent 
knowledge of and access to such program, in-
cluding a discussion of actions the Secretary 
may take to address these factors; and 
‘‘(iv) an assessment of the average wait 
time for an eligible dependent enrolled in the 
program to access alternative health coverage 
for a qualifying condition (as such term is de-
fined in such section), including a discussion of 
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any adverse health outcomes associated with 
such wait.’’. 
SEC. 6. EFFECTIVE DATE. 
The amendments made by this Act shall take effect 
October 1, 2020. 
Æ 
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