Title: TRICARE ECHO Improvement Act
Policy area: Armed Forces and National Security

Summary:
TRICARE ECHO Improvement Act
This bill expands benefits available under the TRICARE Extended Health Care Option program for beneficiaries with special needs, including by expanding coverage of respite care and durable medical equipment.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6148 Introduced in House (IH)]

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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 Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``TRICARE ECHO Improvement Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Active duty members of the uniformed services encounter 
        difficulties accessing Home and Community-Based Services (HCBS) 
        waivers under Medicaid 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 additional 
        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 military 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 established as an alternative to 
        HCBS waivers for military families. The ECHO program provides 
        additional medical and non-medical services not covered by 
        TRICARE to eligible military dependents with special needs, for 
        the purpose of assisting in the reduction of the disabling 
        effects of the qualifying condition of the dependent.
            (6) The Military Compensation and Retirement Modernization 
        Commission concluded that, although ECHO was created as an 
        alternative to HCBS waiver benefits, ``ECHO benefits, as 
        currently implemented, are not robust enough to replace state 
        waiver programs when those programs are inaccessible.''
            (7) Although the purpose of the ECHO program is to provide 
        supplemental services to dependents with special needs, a 2014 
        study conducted by the Manpower Data Center of the Department 
        of Defense found that only 37 percent of military families 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 deserve--
            (1) equitable access to critical services that minimize the 
        debilitating effects of a disabling condition; 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 Dependents.--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 patient) 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 services other than part-time or 
        intermittent services (within the meaning of such terms as used 
        in the second sentence of section 1861(m) of the Social 
        Security 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 institutions and facilities.
            ``(E) Custodial care, notwithstanding the prohibition in 
        section 1077(b)(1) of this title.
            ``(F) In accordance with paragraph (2), respite care for 
        the primary caregiver of the eligible dependent.
            ``(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 furnished 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), adaptations to the 
        private residence and vehicle of the eligible dependent.
            ``(K) Such other services and supplies as determined 
        appropriate by the Secretary, notwithstanding the limitations 
        in subsection (a)(12).
    ``(2) Respite care under paragraph (1)(F) shall be provided subject 
to the following conditions:
            ``(A) Such respite care shall be limited to 50 hours in 
        each month.
            ``(B) Unused hours of respite care may not be carried over 
        to another month.
            ``(C) Such respite care may be provided to an eligible 
        beneficiary regardless of whether the eligible beneficiary is 
        receiving another benefit under this subsection.
    ``(3)(A) Service and modification of durable equipment and 
assistive technology devices under paragraph (1)(G) may be provided 
only upon determination by the Secretary that the service or 
modification is necessary for the use of such equipment or device by 
the eligible dependent.
    ``(B) Service and modification of durable equipment and assistive 
technology devices under such paragraph may not be provided--
            ``(i) in the case of misuse, loss, or theft of the 
        equipment or device; or
            ``(ii) for a deluxe, luxury, or immaterial feature of the 
        equipment or device, as determined by the Secretary.
    ``(C) Service and modification of durable equipment and assistive 
technology devices under such paragraph may include training of the 
eligible dependent and immediate family members of the eligible 
dependent on the use of the equipment or device.
    ``(4)(A) Adaptations to the private residence and vehicle of the 
eligible dependent under paragraph (1)(J) may be provided if such 
adaptations--
            ``(i) are determined to be medically necessary by the 
        provider responsible for the care of the eligible dependent 
        with respect to the qualifying condition; and
            ``(ii) are necessary to assist in--
                    ``(I) the reduction of the disabling effects of the 
                qualifying condition; or
                    ``(II) maintenance of the present functionality of 
                the eligible dependent.
    ``(B) With respect to a vehicle, adaptations may be provided under 
such paragraph if the vehicle is the primary means of transportation of 
the eligible dependent.''.

SEC. 5. ADDITIONAL REQUIREMENTS IN OFFICE OF SPECIAL NEEDS ANNUAL 
              REPORT.

    Section 1781c(g)(2) of title 10, United States Code, is amended--
            (1) by redesignating subparagraph (C) as subparagraph (D); 
        and
            (2) by inserting after subparagraph (B) the following 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 information provided 
                by families of eligible dependents;
                    ``(iii) an assessment of factors that prevent 
                knowledge of and access to such program, including 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 defined in such section), including a 
                discussion of any adverse health outcomes associated 
                with such wait.''.

SEC. 6. EFFECTIVE DATE.

    The amendments made by this Act shall take effect October 1, 2020.
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