H.R. 4341 (112th): 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.

112th Congress, 2011–2013. Text as of Mar 29, 2012 (Introduced).

Status & Summary | PDF | Source: GPO

I

112th CONGRESS

2d Session

H. R. 4341

IN THE HOUSE OF REPRESENTATIVES

March 29, 2012

(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.

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;

(B)

are developed and determined proactively and comprehensively; and

(C)

ensure and maintain their access to pediatric-specific treatments, providers, and facilities;

(2)

children’s health-care needs and standards of care are different and distinct from those of adults, therefore the TRICARE program should undertake a proactive, comprehensive approach to review and analyze its policies and practices to meet the needs of children to ensure that children and their families receive appropriate care in proper settings 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 children with special-health-care needs and chronic-health conditions;

(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 programs, including the ECHO program, but there are collateral needs that are not being met, generally because the services are provided in the local community 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 Department of Defense, a gap exists between linking military families with children with special-health-care needs and chronic conditions with the resources and services available from local or regional highly specialized providers and the communities and States in which they reside;

(8)

the gap is especially exacerbated by the mobility of military families, who often move from State to State, because special-needs health care, educational, and social services are very specific to 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 children that are provided by States and local communities.

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 paragraph (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;

(ii)

recommend changes to such policies and practices to ensure that—

(I)

children receive appropriate care in an appropriate manner, at the appropriate time, and in an appropriate 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 pediatric-specific health care and pediatric-specific healthcare settings;

(ii)

analyze the direct and indirect effects of the reimbursement policies and practices of the TRICARE program with respect to pediatric care and care provided in pediatric settings;

(iii)

consider case management programs with respect to pediatric complex and chronic care, including whether pediatric 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 program can work with the pediatric provider community to ensure access, promote communication 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 families in the TRICARE program who have children with special-health-care needs access community resources and health-care resources;

(ii)

review how having access to, and a better understanding of, community resources may improve access to health care and support services;

(iii)

recommend methods to accomplish 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 integration 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 chronic-health-care needs; and

(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 manner with respect to improving access, resources, and services for adults with special 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 protect families of members of the National Guard or Reserve Components as the members transition into and out of the relevant Exceptional Family Member Program 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 the TRICARE program or the ECHO program and how to coordinate such services;

(v)

identify steps that States and communities can take to improve support for military families of children with special health care needs;

(vi)

consider how the TRICARE program and other programs of the Department of Defense can work with specialty pediatric providers and resource communities to ensure access, promote communication and collaboration, and optimize experiences of military families seeking and receiving health care services for their children 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 innovative partnerships, linkages, and access to information and resources for military families across the spectrum of the special-needs community and between the medical community and the family support community; 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 chairperson.

(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 regional managed care support contractor of the North region of the TRICARE program appointed by such contractor.

(G)

One individual representing the regional managed care support contractor of the South region of the TRICARE program appointed by such contractor.

(H)

One individual representing the regional managed care support contractor of the West region of the TRICARE program appointed by such contractor.

(I)

Not more than three individuals representing the non-profit organization the Military Coalition appointed by such organization.

(J)

One individual representing the American Academy of Pediatrics appointed by such organization.

(K)

One individual representing the National Association of Children’s Hospitals appointed by such organization.

(L)

One individual representing military families who is not an employee of an organization representing such families.

(M)

Any other individual as determined by the Chief Medical Officer of the TRICARE program.

(2)

Terms

Each member shall be appointed for the life of the working group. A vacancy in the 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 ensure that employees of the TRICARE program provide 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

(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 testimony, 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 agencies of the United States.

(e)

Consultation

(1)

Advice

With respect to carrying out the review of the TRICARE program and pediatric special 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 Exceptional Family Member Program of the Army.

(B)

One individual representing the Exceptional Family Member Program of the Navy.

(C)

One individual representing the Exceptional Family Member Program of the Air Force.

(D)

One individual representing the Exceptional 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 representing 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 subsection (a)(3), the working group shall invite and accept comments and testimony from States, local 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 including—

(A)

any changes described in subsection (a)(2)(A)(ii) identified by the working group that—

(i)

require legislation to carry out, including 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 legislation or regulations, including a time line for such changes; and

(B)

steps that States and local communities may take to improve the experiences of military families with special-needs children in 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 submit to the congressional defense committees a final report including—

(A)

any additional information and updates 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 paragraph that were taken by States and local communities after the date on which such report was submitted.

(g)

Termination

The working group shall terminate 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:

(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 dependents is applicable and relevant to a program or policy being reviewed under this Act.

(2)

The term congressional defense committees has the meaning given that term in section 101(a)(16) of title 10, United States Code.

(3)

The term ECHO program means the program 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.