1.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)
(1)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)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)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)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)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)
(1)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)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)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)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)
(1)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)Any
meeting of the working group may be conducted in-person or through the use of
video conferencing.
(3)Seven members of the working group shall
constitute a quorum but a lesser number may hold hearings.
(d)
(1)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)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)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)
(1)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)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)
(1)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)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)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)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.