TRICARE ECHO Improvement Act

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- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘TRICARE ECHO Im- 4 provement Act’’. 5 SEC. 2. FINDINGS. 6 Congress finds the following: 7 (1) Active duty members of the uniformed serv- 8 ices encounter difficulties accessing Home and Com- 9 VerDate Sep 11 2014 03:41 Mar 14, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H6148.IH H6148 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 6148 IH munity-Based Services (HCBS) waivers under Med- 1 icaid for the dependents of such members who have 2 intellectual or developmental disabilities. 3 (2) State residency requirements create barriers 4 to accessing such benefits for military families who 5 move across State lines and are required to reenroll 6 with each permanent change of station. 7 (3) Enrollment caps for such waivers create ad- 8 ditional barriers, and often result in waiting lists 9 due to the demand for such waivers, including, in 10 2017, an average 30-month wait time. 11 (4) The Military Compensation and Retirement 12 Modernization Commission concluded that ‘‘access to 13 HCBS waiver benefits is a substantial issue for mili- 14 tary families . . . Service members are required to 15 re-apply for benefits each time they move to a new 16 state. Many Service members encounter waiting lists 17 that exceed their time assigned to a location.’’. 18 (5) In 2001, the TRICARE Extended Care 19 Health Option program (‘‘ECHO program’’) was es- 20 tablished as an alternative to HCBS waivers for 21 military families. The ECHO program provides addi- 22 tional medical and non-medical services not covered 23 by TRICARE to eligible military dependents with 24 special needs, for the purpose of assisting in the re- 25 VerDate Sep 11 2014 03:41 Mar 14, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H6148.IH H6148 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 6148 IH duction of the disabling effects of the qualifying con- 1 dition of the dependent. 2 (6) The Military Compensation and Retirement 3 Modernization Commission concluded that, although 4 ECHO was created as an alternative to HCBS waiv- 5 er benefits, ‘‘ECHO benefits, as currently imple- 6 mented, are not robust enough to replace state waiv- 7 er programs when those programs are inaccessible.’’ 8 (7) Although the purpose of the ECHO pro- 9 gram is to provide supplemental services to depend- 10 ents with special needs, a 2014 study conducted by 11 the Manpower Data Center of the Department of 12 Defense found that only 37 percent of military fami- 13 lies that have a child with special needs were aware 14 of the program. 15 (8) The Conference Report accompanying the 16 National Defense Authorization Act for Fiscal Year 17 2010 stated that ‘‘expanding support for families 18 with special needs is a critical requirement for the 19 all-volunteer force.’’. 20 SEC. 3. SENSE OF CONGRESS. 21 It is the sense of Congress that military families de- 22 serve— 23 VerDate Sep 11 2014 03:41 Mar 14, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H6148.IH H6148 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 6148 IH (1) equitable access to critical services that 1 minimize the debilitating effects of a disabling condi- 2 tion; and 3 (2) an evaluation of the effectiveness of current 4 services under the ECHO program. 5 SEC. 4. EXPANSION OF BENEFITS AVAILABLE UNDER 6 TRICARE EXTENDED HEALTH CARE OPTION 7 PROGRAM. 8 (a) EXTENDED BENEFITS FOR ELIGIBLE DEPEND- 9 ENTS.—Subsection (e) of section 1079 of title 10, United 10 States Code, is amended to read as follows: 11 ‘‘(e)(1) Extended benefits for eligible dependents 12 under subsection (d) may include comprehensive health 13 care services (including services necessary to maintain, or 14 minimize or prevent deterioration of, function of the pa- 15 tient) and case management services with respect to the 16 qualifying condition of such a dependent, and include, to 17 the extent such benefits are not provided under provisions 18 of this chapter other than under this section, the following: 19 ‘‘(A) Diagnosis and screening. 20 ‘‘(B) Inpatient, outpatient, and comprehensive 21 home health care supplies and services which may 22 include cost effective and medically appropriate serv- 23 ices other than part-time or intermittent services 24 (within the meaning of such terms as used in the 25 VerDate Sep 11 2014 03:41 Mar 14, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H6148.IH H6148 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 6148 IH second sentence of section 1861(m) of the Social Se- 1 curity Act). 2 ‘‘(C) Rehabilitation and habilitation services 3 and devices. 4 ‘‘(D) Institutional care in private nonprofit, 5 public, and State institutions and facilities and, if 6 appropriate, transportation to and from such institu- 7 tions and facilities. 8 ‘‘(E) Custodial care, notwithstanding the prohi- 9 bition in section 1077(b)(1) of this title. 10 ‘‘(F) In accordance with paragraph (2), respite 11 care for the primary caregiver of the eligible depend- 12 ent. 13 ‘‘(G) In accordance with paragraph (3), service 14 and modification of durable equipment and assistive 15 technology devices. 16 ‘‘(H) Special education. 17 ‘‘(I) Vocational training, which may be fur- 18 nished to an eligible dependent in the residence of 19 the eligible dependent or at a facility in which such 20 training is provided. 21 ‘‘(J) In accordance with paragraph (4), adapta- 22 tions to the private residence and vehicle of the eligi- 23 ble dependent. 24 VerDate Sep 11 2014 03:41 Mar 14, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H6148.IH H6148 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 6148 IH ‘‘(K) Such other services and supplies as deter- 1 mined appropriate by the Secretary, notwithstanding 2 the limitations in subsection (a)(12). 3 ‘‘(2) Respite care under paragraph (1)(F) shall be 4 provided subject to the following conditions: 5 ‘‘(A) Such respite care shall be limited to 50 6 hours in each month. 7 ‘‘(B) Unused hours of respite care may not be 8 carried over to another month. 9 ‘‘(C) Such respite care may be provided to an 10 eligible beneficiary regardless of whether the eligible 11 beneficiary is receiving another benefit under this 12 subsection. 13 ‘‘(3)(A) Service and modification of durable equip- 14 ment and assistive technology devices under paragraph 15 (1)(G) may be provided only upon determination by the 16 Secretary that the service or modification is necessary for 17 the use of such equipment or device by the eligible depend- 18 ent. 19 ‘‘(B) Service and modification of durable equipment 20 and assistive technology devices under such paragraph 21 may not be provided— 22 ‘‘(i) in the case of misuse, loss, or theft of the 23 equipment or device; or 24 VerDate Sep 11 2014 03:41 Mar 14, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H6148.IH H6148 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 6148 IH ‘‘(ii) for a deluxe, luxury, or immaterial feature 1 of the equipment or device, as determined by the 2 Secretary. 3 ‘‘(C) Service and modification of durable equipment 4 and assistive technology devices under such paragraph 5 may include training of the eligible dependent and imme- 6 diate family members of the eligible dependent on the use 7 of the equipment or device. 8 ‘‘(4)(A) Adaptations to the private residence and ve- 9 hicle of the eligible dependent under paragraph (1)(J) may 10 be provided if such adaptations— 11 ‘‘(i) are determined to be medically necessary 12 by the provider responsible for the care of the eligi- 13 ble dependent with respect to the qualifying condi- 14 tion; and 15 ‘‘(ii) are necessary to assist in— 16 ‘‘(I) the reduction of the disabling effects 17 of the qualifying condition; or 18 ‘‘(II) maintenance of the present function- 19 ality of the eligible dependent. 20 ‘‘(B) With respect to a vehicle, adaptations may be 21 provided under such paragraph if the vehicle is the pri- 22 mary means of transportation of the eligible dependent.’’. 23 VerDate Sep 11 2014 03:41 Mar 14, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H6148.IH H6148 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 6148 IH SEC. 5. ADDITIONAL REQUIREMENTS IN OFFICE OF SPE- 1 CIAL NEEDS ANNUAL REPORT. 2 Section 1781c(g)(2) of title 10, United States Code, 3 is amended— 4 (1) by redesignating subparagraph (C) as sub- 5 paragraph (D); and 6 (2) by inserting after subparagraph (B) the fol- 7 lowing new subparagraph (C): 8 ‘‘(C) With respect to the Extended Care Health 9 Option program under section 1079(d) of this title— 10 ‘‘(i) the utilization rates of services under 11 such program by eligible dependents (as such 12 term is defined in such section) during the prior 13 year; 14 ‘‘(ii) a description of gaps in such services, 15 as ascertained by the Secretary from informa- 16 tion provided by families of eligible dependents; 17 ‘‘(iii) an assessment of factors that prevent 18 knowledge of and access to such program, in- 19 cluding a discussion of actions the Secretary 20 may take to address these factors; and 21 ‘‘(iv) an assessment of the average wait 22 time for an eligible dependent enrolled in the 23 program to access alternative health coverage 24 for a qualifying condition (as such term is de- 25 fined in such section), including a discussion of 26 VerDate Sep 11 2014 03:41 Mar 14, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H6148.IH H6148 kjohnson on DSK79L0C42PROD with BILLS 9 •HR 6148 IH any adverse health outcomes associated with 1 such wait.’’. 2 SEC. 6. EFFECTIVE DATE. 3 The amendments made by this Act shall take effect 4 October 1, 2020. 5 Æ VerDate Sep 11 2014 03:41 Mar 14, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6301 E:\BILLS\H6148.IH H6148 kjohnson on DSK79L0C42PROD with BILLS