[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2987 Introduced in House (IH)]







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 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.


_______________________________________________________________________


                    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 Program 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 Representatives 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 INDIVIDUAL 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 program, and the 
        furnishing of care to those beneficiaries, 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 striking 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 specified 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 Secretaries 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 subsection:
    ``(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 authorized 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 Defined.--Section 1072 of title 
10, United States Code, is amended by adding at the end the following 
new paragraphs:
            ``(8) The term `domiciliary care' means treatment or 
        services involving assistance with the performance 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 
                        reasonably by a person not trained as a 
                        physician, 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 described 
                in subparagraph (A) without regard to--
                            ``(i) the source of any recommendation to 
                        provide the treatment or service; and
                            ``(ii) the setting in which the treatment 
                        or service is provided.''.

SEC. 103. CONFORMING REPEALS.

    The following provisions of law are repealed:
            (1) Section 703 of the National Defense Authorization 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:
``Sec. 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 services provided in a skilled nursing facility 
to a patient during 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 subsections (a)(2) 
and (b)(2)(A) of section 1812 of the Social Security Act (42 U.S.C. 
1395d) shall not apply with respect to the care provided that patient.
    ``(d) Regulations.--The Secretary of Defense shall, after 
consultation with the other administering Secretaries, 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 Security 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 BENEFICIARIES.

    Section 1079 of title 10, United States Code, is amended by 
striking subsections (d), (e), and (f) and inserting 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 psychological 
        condition.
    ``(2) The extended benefits shall include comprehensive health care 
and case management services, to the extent not otherwise provided 
under this chapter with respect to a qualifying condition, as follows:
            ``(A) Diagnosis.
            ``(B) Inpatient, outpatient, and comprehensive home health 
        supplies and services.
            ``(C) Training and rehabilitation, including special 
        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 determined 
        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 provided 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 appropriate; 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 facility.
    ``(5) Subsection (a)(13) shall not apply to the provision of care 
and services determined appropriate to be provided 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 enlisted 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 cumulative costs of all care 
        furnished to one or more dependents 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 regulations to carry out 
this subsection.''.

SEC. 203. REPORT TO CONGRESS ON RELATIONSHIP AMONG FEDERAL LONG-TERM 
              CARE INITIATIVES.

    Not later than April 1, 2002, the Secretary of Defense 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 NECESSARY.

    (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 subparagraph (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 designated by 
        subparagraph (A), the following new subparagraph:
    ``(B) For the purposes of subparagraph (A), the determination that 
a service or supply is medically or psychologically 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 
conclusive unless the physician's determination is clearly erroneous, 
as determined by a higher authority or under the CHAMPUS Peer Review 
Organization program.''.
    (b) Determinations Not Subject to Peer Review.--Subsection (o)(1) 
of such section is amended by inserting ``(subject to subsection 
(a)(13)(B))'' after ``determined''.

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 subsection (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 hearing loss, as determined under 
        standards prescribed in regulations by the Secretary of Defense 
        in consultation with the administering Secretaries.'';
            (2) in subsection (b)(2), by striking ``Hearing aids, 
        orthopedic footwear,'' and inserting ``Orthopedic footwear''; 
        and
            (3) by adding at the end the following new subsection:
    ``(f)(1) Authority to provide a prosthetic or orthotic device under 
subsection (a)(15) includes authority to provide 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 functioning.
            ``(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 regulations prescribed by the Secretary of Defense 
in consultation 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 inserting 
        ``which''; and
            (2) by adding at the end the following new subsection:
    ``(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 malformed, diseased, or 
        injured body part, or can otherwise minimize or prevent the 
        deterioration of the patient's function or condition.
            ``(B) Any durable medical equipment that can maximize the 
        patient's function and mobility consistent 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 patient;
            ``(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 equipment by the patient is transportation, comfort, or 
convenience of the patient.''.
    (b) Provision of Items on Rental Basis.--Paragraph (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 inserting after paragraph (16) 
the following new paragraph:
            ``(17) Any rehabilitative therapy to improve, restore, or 
        maintain function, or to minimize or prevent deterioration of 
        function, of a patient when prescribed by a physician, 
        including the following therapies:
                    ``(A) Physical or occupational therapy to maintain 
                range of motion in a paralyzed extremity of the 
                patient, without regard to whether a purpose for 
                providing the therapy is to restore 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, including gait 
                analysis.
                    ``(C) Respiratory or recreation therapy that is 
                included as part of a treatment plan established 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 paragraphs:
    ``(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 reduced 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 entered 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.
                                 <all>